A Sustainable Approach to The cost to the health economy in the UK - - PDF document

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A Sustainable Approach to Telehealthcare in Tameside and Glossop

Christine Craig Service Unit Manager Tameside Borough Council 19th May 2015

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Tameside Specific Health/Social Care

• The cost to the health economy in the UK is

currently under immense pressure

• What this means for Tameside
• Hospital in crisis
• Drivers for change:
• The Care Act 2015
• Integration/Care Together

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Population - Tameside

• Tameside population
• Tameside is made up of 9

towns

• Tameside’s Health
• Council’s drivers for change
• Telehealth wellbeing

Tameside Statistics Population 216,731 People aged 0-15 42,364 19.55% People aged 16-29 39,189 18.08% People aged 30-44 44,460 20.51% People aged 45-64 56548 26.09% People aged 65 and over 34,170 15.77% Average life expectancy (Male) 75.97341 Average life expectancy (Female) 80.97166 Size of area in km2 103.1685 Size of area in sq mi 39.82112 Population per km2 2100.748 Population per sq mi 5442.614

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How can Telehealth help?

Timely, Accurate and Targeted Health Information

• More frequent & regular information gathered
• Vital sign observations
• Health questionnaires
• Targeted self care advice given
• Patient feels daily engagement with their care

Timely & Appropriate Care

• Identifying trends allows early intervention to prevent

exacerbations

• Maintain Patient in a low cost setting whilst improving care
• Prevent Patient presenting in practice in advanced condition
• Support better medication prescription & compliance
• Easily gauge the impact of medication change

Cost Savings

• Saving in reduction for non elective admissions
• Shift to less costly interventions (e.g. telephone

consultation, nurse visit self care intervention instead of GP, A&E attendance

• More effective medication prescription

Improved Quality of Life

• Patient feels more in control
• Patient and or Carer may feel less

anxiety

• Patient remains at home for longer

Better Self Management

• Patient has increased awareness

& engagement of their condition

• Greater likelihood of lifestyle

changes being adopted Improved Health for the Patient Conditions stabilised, better health & less likelihood of exacerbations Fewer Unplanned Interventions Reduction in A&E visits and hospitalisations

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Telehealth

The Telehealth function is commissioned by Tameside & Glossop CCG and this service provides equipment fitting and advice services, technical triage and monitoring, and the provision of 24 hour help and advice. Medical interventions are provided by the

• NHS. The focus of this service is to provide medical screening in

the patient’s home, and reduces the frequency of visits to the GP and hospital. Telehealth is a service to support patients with long term conditions (CHF and/or COPD) in Tameside and Glossop. The service uses Telehealth monitoring appliances to transmit daily information about a patient’s condition, including weight, blood pressure, oxygen levels and temperature. Responsible clinicians will monitor this information and provide immediate support where

• necessary. Telehealth enables individuals to manage their long

term condition effectively at home, reduce exacerbations, and can result in an early diagnosis of unforeseen health related problems, as well as empowering patients to take a more active role in their care. It is envisaged that this service will help to reduce unnecessary A&E attendances, hospital admissions,

• utpatient attendances and length of stay in hospital.

Here at the Community Response Service, we currently technically triage 265 Telehealth units/patients. The MyMedics installed are split between patients with CHF, and/or COPD.

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Telehealth Concept

Secure N3 IT & Communications Network

Triage & Clinical Monitoring Telehealth ‘MyMedic’

Patient feedback

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Infrastructure for Managing Mainstream Telehealth Services

Prioritised & appropriate clinical intervention: phone consultation, self-care advice, home visits, GP appointments etc. Clinical assessment of validated data Technical triage validation

• f all data

Patient data accessed via web-based triage software Identifiable data hosted in N3-environment Anonymised data transmitted via secure telephone Daily data collection: vital signs and health question responses Patient trained and equipment installed by on- site visit Community Response installation visit scheduled Community Response Patient enrolled via online web portal Patient referred for Telehealth Service

Tameside Council Managed Service NHS Tameside & Glossop 8

The ‘MyMedic’ supports multiple languages, vital signs, devices and condition specific health interviews

User Interface

• Text and audio
• Vocal prompts can be recorded locally
• Language & dialects supported
• Large graphic colour display
• Variable text size
• Pictures

Information Exchange

• Condition specific health questions &

‘branching’

• Reminders
• Self-care and advice
• Medication prompts
• Repeats readings to Patient

Medical Device Readings

• Blood Glucose
• Blood Pressure
• Weight
• Pulse
• Oxygen Saturation
• INR
• Temperature
• Peak Flow
• ECG

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MyClinic supporting multiple Patients in one location. E.g. Residential Care Home, GP Practice

• Proposals for the future
• Group Homes/Extra Care Housing
• Residential and Nursing Care
• GP Surgeries
• Pharmacies

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Telehealth Pilot

• Approval was given by PCT to pilot 60 Patents in October 2011
• Aim by March 2012 was for a further 145 Patients
• Currently monitoring 265 Patients

Evaluation of Pilot

• Emergency admissions reduced by

35%

• A&E attendances reduced by 40%
• Outpatient attendances reduced by

20%

• Length of stay reduced by 70%

Patient Evaluation

• Improved self-management of their condition
• 83% of Patients reported improved quality of

life

• 95% said the information given was easy to

understand

• 88% said equipment was easy to use

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Present Times Versus Future Outlook

Present

• People aged 60yrs plus account for 55%
• f the NHS budget
• Of people in community hospitals, 40%

could be supported & cared for at home

• There are 30% of older people in

residential homes that are inappropriately placed

• Accident rates for older people continue

to increase

Future

• People are living longer without family

support

• Over the next 50yrs, over 65’s are set to

double

• An increased need for community based

care/support

• Higher expectations
• Want/need to remain independent, have

choices and maintain dignity (Source Department of Health)

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Telehealthcare

Joanne Strothers Telehealthcare Manager Tameside Borough Council 19th May 2015

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Today’s Objectives

• To increase your knowledge of Telecare
• To equip you with the knowledge of how the Service and Equipment can

support individuals to remain at home

• To give you information to enable you to offer choices to individuals

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My Right to Choose

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Building Telecare

“Councils are expected to invest in providing choices, health, and wellbeing for a diverse range of Clients”

(Building Telecare in England DOH 2005)

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Telecare – The Facts

The Preventative Technology Grant

• There was an £80 million in grant finance over 2 years from

2006-2008

• Tameside’s share of this grant was £383,537
• Designed to help local authorities with Social Care

responsibilities, and their partners to address the challenges of a changing and ageing society

• To support Service Users’ increasing independence,

expectations, control, choice and dignity within their own lives

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Telecare – The Facts

The Aims

• To remain at home for longer with safety and security
• To reduce inappropriate admissions to Residential Care and Nursing

Care

• To encourage earlier/safer discharge from hospital to home
• To allow more personal freedom and reassurance for Carers
• To meet potential shortfalls in the workforce as complimentary care

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Telecare – The Facts

Getting the right balance

• Balance between the use of technology and continued human contact
• Care must be taken to ensure that technologies do not control or isolate people
• Some care services will always be delivered personally
• Human contact is imperative in maintaining quality of life
• Technologies will compliment traditional forms of care

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Tameside Community Response Service

Proud to be a Service

• We operate 24 hours a day, 7 days a week,

365 days per year

• CRS is open to all ages
• We stretch our Service across Older

Peoples Services, Learning Disability Services, Physical Disabilities, Mental Health and Children’s Services

• We cover the whole of Tameside with a 20

minute response time

• We install our own equipment, carry out

reviews, equipment tests and property risk assessments

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Tameside Community Response Service

Our Team

• We run the Service with 36 members of staff (3 Service Coordinators,

2 Operational Support Officers, 1 Modern Apprentice, 19 Community Response Workers and 11 Emergency Control Operators)

• As a team we have over 367 years’ experience

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What is Telecare?

Telecare is an enhanced monitoring system that supports and compliments a package of personalised care.

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Why are we providing Telecare in Tameside?

• To offer choice and flexibility of service provision from a standard Community

Alarm Service to an enhanced monitoring system

• A total of 90% of people say they want to live in their own homes
• As many as 35% of these could be supported in their own homes with Telecare
• Over 1.6 million emergency admissions were made in 2013/2014
• Telecare has the potential to reduce unnecessary admissions and improve the

quality of life

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Telecare is essential in unlocking the demands in Tameside

• Not realistic to plan to deliver care & support services in the way we do

at present

• Services will take on new patterns of working to meet changing care &

support needs and user choices, moving towards reablement and away from dependency

• Tameside’s Community Services have made a commitment to invest

technology

• To meet Government agenda’s and the increasing demographic trends

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Our Emergency Control Centre

• From April 2014 to March 31st 2015 the Emergency Control Centre handled

172,849 inbound calls from service user’s devices this could either be a care- phone, pendent, smoke, wander alerts or other numerous devices. From the inbound calls the community response workers physically attended 11,975 times in response to the activations from the equipment. We have 11 Emergency Control Operators who work 24hrs, 7 days a week, 365 days per year.

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Our Response Service

We currently have 18 Community Response Workers covering 24 hours a day, 7 days a week, 365 days per year Last year, we physically responded to 11,975 activations of equipment by Service Users

20 Minute Response

• We aim to attend all calls that require a Warden

within 20 minutes

• Over the last year we arrived in less than 20

minutes to 90.2% of calls

Under 20 Minutes Under 45 Minutes Under 60 Minutes

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Call Breakdown

The Community Response Service attends a wide variety of calls across the Tameside area. Our Wardens are fully equipped to deal with all types of calls, and have the necessary equipment in place to be able to do so. With the use of Camel and Elk cushions, the Wardens are able to assist up Clients who have fallen. This reduces the number of Ambulance calls, and also reduces the length of time the Client has to wait for assistance. Over the last year we have attended 1976 calls for Clients that had fallen.

Faulty Equipment Activated in Error Property Home Care Tasks Toilet Fall GP Fire Ambulance Access to Property Reassurance

Falls Statistics – UK

• 200 elderly or frail people fall
• ver every hour during the day
• 450 elderly or frail people fall
• ver every hour at night
• 20% are admitted to hospital
• 3% are seriously injured or die

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Our Partnership Working

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Access to the Service

Service User Methods; Phone, Mail, Email Family/Friends/Carers Professionals Referral details taken Contact, arrange date and time to install Visit/Inform/Install Collect details, risk assessment etc.

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Telecare Outcomes

Mrs B (78yrs), lives alone in private accommodation

• Diagnosed with Dementia 18 months ago (progressively worsening)
• Good family support
• Prone to wandering during night time, leaving the gas cooker on etc.
• Family considering Residential Care

Telecare Intervention Door Contacts, Smoke Detector and Gas Detector fitted Actual savings since installation

• £450.00 per week x 56 weeks = £25,200
• £5.90 per week x 56 weeks = £330.40
• Total savings £24,869

Mrs B remained in her own home living safely and independently for 56 weeks

Smoke Detector Gas Detector

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Our Clients

• The Community Response Service currently has

4072 Clients using our services

• Community Response provides services to

customers through an alarm

• A customer may have a ‘hardwired’ alarm or

community alarm installed in their home which connects to the landline and the electric supply. At March 2015, Community Response provided services to 4072 living across the Tameside Borough

• The current charge is £5.90 per week for a 24 hour
• service. The cost includes a wide range of

Telecare devices installed to individual needs which is, monitored and maintained by the service

18-64 65-74 75-84 85+

In December 2014 an exercise was undertaken to evidence the number

• f Service Users in receipt of CRS

and a package of care from Adult

• Services. This equated to 27.6%

which indicates that of our Service Users, 72.94% only have CRS. 38.2% have been diagnosed with Dementia. Of our 4072 Service Users: 11% are between 18-64yrs 19% are between 65-74yrs 36% are between 75-84yrs 34% are over the age of 85

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What our Customers have said

“Many thanks to you all for your quick responses and caring always. I had a weekend of falls which I am so sorry for each fall was through my over- reaching; I am determined not to do this again. I hope you all have a lovely summer I am so grateful.” (Mrs Wilkin) “Dear wonderful workers, On behalf of my mum we both wish to thank you so very much for the fantastic support and help you have given to us over the past years. On the occasions when response and assistance was required the team has acted with care and thoughtfulness. My mum has now moved into Residential Care therefore has no further need for your valued service”. (L. Gilbert) “To everyone at the Community Response Service, Thank you for the excellent service you provided for my father. Sadly he has passed away However; he was able to stay in his own home until a few days before he passed

• away. Your prompt action when he activated his alarm meant the ambulance crew was
• nsite promptly. The service gave us precious extra months that allowed us to support

Dad in his home.” (J&P Houldridge)

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“What Telecare means to me”

Mick Burkhill

I feel in one word that Telecare has given me my life back

Longer to live a near normal life for longer Independent still live independently in the community Fuller fuller life complete with more freedom Existence exist in safety to live another day

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Takk for

• ppmerksomheten!

joanne.strothers@tameside.gov.uk

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Learning Disability Services

Alison White Service Unit Manager Long Term Support Tameside Borough Council 19th May 2015

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Assistive Technology Learning Disability Services

Long term support manages services to 81 adults with learning disabilities sharing properties in the community

Services in the Community

• There is a cost implication to services in individual

houses in the community

• Staff 24 hours
• Sleep in every night

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New Services Developed

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• Enables services to run

without the same cost to the service

• Consultation with

service users

Moving from houses to flats Kevin Quirke – two years on

Complex Service User’s who live at Carlton Springs

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Carlton Springs Budget

• Stamford Street is where 4 of the service users at

Carlton lived independently.

• Hours for this property were 1352 hours.
• At Carlton we support another 12 service users for only

an average extra 200 hours per month.

• This is continuing to reduce as shown on the graph we

started by using 1950 and we are now down to 1550.

• We have also carried maternity of 120 hours per

month taking this away we are managing on 1430

• S has 19 hours ILF, I has 14 hours ILF and M has 8

hours direct payment per week.

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Carlton spring reduction in hours over the last 8 months

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Services Developed - greater independence

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Services that include assistive technology promote

• Greater independence
• My own home
• Saves money
• Gives control to the service user
• Reassurance to family and individual

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Tusen Takk

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