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Lee davis hull wsdan 30 june 2011
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Lee davis hull wsdan 30 june 2011 Presentation Transcript

  • 1. Telecare in Wales
    Lee Davis
    Welsh Government
    07808 727466
    029 2080 1410
    Lee.Davis@Wales.GSI.gov.uk
    www.ssiacymru.org.uk/telecare
  • 2. Why is there so little Telehealth ?
  • 3. Wales
    Population under 3 million
    22 Local Authorities
    7 LHBs
    All Co-Terminus with one or more local authority
    So :
    Regionalisation
    Pooled Budgets
  • 4. Welsh ‘Call Centres’ In 2006
    22 (23?) call centres mostly only 5,000 connections
    Only one with over 10,000 connections
    Every LA had one
    Costs not known
    Value not known
    Potential not understood
  • 5. Regionalisation
    North Wales Regional Telecare Service
    6 local authorities and one LHB working through one call centre (admittedly on two sites)
    South East Wales Improvement Collaborative (SEWIC)
    10 Local Authorities and 3 LHBs
    Encompassing Gwent Frailty Project
    Carmarthenshire & HywellDda RCT
  • 6. Sustaining Social Services – A Framework for Action
    Regionalisation
    Cost
    Integration of Telecare & Telehealth
    Links with ICES
  • 7. Cardiac arrest
    Cognition
    Nutrition
    Flood
    Fire
    Medication
    Gas
    Asthma attack
    Mobility
    Intruders
    Telecare to Manage Risk
    Environmental
    And Security
    Medical
    Social
  • 8. A Robust Business Case !?
    A telecare enhanced care package is on average cheaper to social services than residential care only if the package is less than about 20 hours per week…
  • 9. A Robust Business Case !?
    Random Sampling:
    Where institutional care is avoided social care costs were on average reduced by £216 per week
    Where telecare can mean a reduced care package at home the cost avoidance is on average £257 per week
  • 10. A Robust Business Case !?
    In one county studied:
    Weekly cost of providing telecare service is under £9 per user per week – elsewhere probably £12-£15
    Across Wales:
    On average 3.29 hospital bed days per year per client – a weekly saving of £14.12 per client
  • 11. John Bolton’s Work for SSIA
    List of 31 things that local authorities should do to save money
    Telecareis Number 2 on that list
    After Re-ablement ( – which it can support)
  • 12. A Robust Business Case !?
    Conclusion
    The potential for a well targeted telecare service to reduce costs for social services is substantial
  • 13. A Robust Business Case !?
    Conclusion
    Telecare is not a cost saving panacea
    Telecare was developed to manage the risks associated with independent living, to contribute to people’s health, mobility, social well-being and security, and ultimately to provide choice
    This should remain its primary goal
  • 14. People Receiving Telecare at midnight on 31December 2009
    17,946
    Total Telecare Service Delivery = 19,699
    Community Alarm users = 100,000 approx
    Home Care Service Users in any given week = 23-24,000
  • 15. Would you describe your telecare service as mainstreamed?
    Yes = 20 (17)(15)
    No = 2 (5)(7)
  • 16. Telehealth
    We don’t Know how many – counting them now
    But
    Carmarthenshire RCT = 240
    Main supplier of Telehealth packages in Wales say that through the Telecare Capital Grant they sold ....
    86 !!
  • 17. Community Alarms
    Personal Contacts
    Existing Social Alarm Monitoring
    Emergency Services
    Monitoring Centre
    They used :
    POTS (plain old telephone system) systems
  • 18. Passive/Reactive Telecare
    Passive Sensors in the home..
    Personal Contacts
    Emergency Services
    Monitoring Centre
    It is still :
    POTS (plain old telephone system) systems
  • 19. Duty Social
    Worker
    Mobile Warden
    Out-of-hours
    GP
    24 Hour --Nurse
    Relatives
    & friends
    24 hour
    Gas fitter
    Advanced
    Lifeline
    Unit
    Emergency
    plumber
    Smart Sensors
    Rapid
    Response
    Team
    Lifting
    service
    24 hr. Home Care
    Fire
    service
    Police
    Contact &
    Coordination centre
    Community
    Alarm
    Centre
    Ambulance
    Alarms – A Reactive Telecare System
    Wireless alarm
    Response Team
  • 20. Community Alarm Centre
  • 21. NHS Direct
    Elderly
    living independently
    Healthcare Professionals
    Home Hub
    Appliance
    Social Worker
    Community Alarm Centre
    Telehealth Care Record
    Home Automation
    Security Wireless Network
    • Lights
    • 22. Doors windows
    • 23. Motion / Activity
    • 24. Bed
    • 25. Drawers
    • 26. Kitchen
    • 27. Bathroom
    Emergency Services
    Care Response Service, Warden etc
    Family, friends and volunteers
    Separate Health & Social Care Systems
    Cholesterol Monitor
    Blood-pressure
    Cuff
    Scales
    Glucose
    Sensor
    Pulse Oximeter
    MedicationTracking
    Coordination Required
  • 28. Contact & Coordination Centres
    Potential Roles:
    Hospital Discharge
    Preventing Admission – co-ordinating services to support at home
    Real Time updating and communication of care plan
    Changing the care package – Responsive.
    Telehealth:
    Installation, Maintenance, Administration
    Traffic Light System means clinical involvement only at last point of process
    This is Mainstreaming Technology !!!
  • 29. Response
    Response
    Team 1
    Response
    Response
    Team 2
    Team 4
    Response
    Team 3
    Integration of Services Cost-effectively
    County 1
    County 2
    Home
    Coordination & Contact centre
    8am–6pm Mon - Fri
    Coordination & Contact centre
    8am–6pm Mon - Fri
    TELECARE
    MONITORING
    CENTRE
    24/7
    Coordination & Contact centre
    8am–6pm Mon - Fri
    Coordination & Contact centre
    8am–6pm Mon - Fri
    Clinic
    County 4
    County 3
  • 30. Telehealth on a Telecare Platform
    We are ready
    Seize the moment with the LHBs & Regional partnerships
    The technology enables us to provide telehealth monitoring services and telecare alarm services alongside.
    We need to be proactive and not miss this opportunity to provide truly integrated services
  • 31. Cottage Industry Thinking
    How far away are we from turning ‘Community Alarm Services’ in to ‘Contact & Co-ordination Centres‘ which can co-ordinate the delivery of integrated health and social care services
    We are so far away that Care Line’ services are not being informed when service users are in care homes or hospital. Many have no idea where users are unless an alarm goes off
    Does all the required service user information go in to the service?
    Does all the call centre’s knowledge of service users’ needs & history inform how you can maintain people’s independence.
    Are the ‘Call Centres’ really full players in the delivery of health & social services
    Are they really part of the mainstream?
    Or are they are still a ‘one-trick-pony’ re-active service?
  • 32. What We Know & What We Need
    Communication Hubs
    3 Functions 3 Contexts
    Library Function National
    Call Handling Regional
    Care Coordination Local
  • 33. Framework of Services for Older People – 2011
    The focus of this ‘Framework of Services for Older People’ will be upon how these public services work together to promote the independence of frail older people either in their own homes or in other homely settings. It will contribute to the achievement of modern, accessible and responsive services capable of meeting people’s needs and of being delivered flexibly, consistently and sustainably across organisational boundaries. In addition to enabling people to live as independently as possible, services must assist them to recover independence where this has been threatened, must promote and protect their dignity, must promote social inclusion, must support them at times of difficulty and protect them from harm.
  • 34. Framework of Services for Older People – 2011
    The word ‘Telecare’ appears 51 times
  • 35. Framework for Telecare
    Within the next few months the Welsh Government will be publishing updated guidance that will build upon lessons learned over the past five years and will continue to promote the strategic development of this service. The guidance will be directed towards ensuring that we make the best use of telecare and realise the benefits of closer integration with other services such as telehealth, community equipment, adaptations, etc. We also need to exploit the potential of the communications centre at the heart of telecare to provide more effective services.
  • 36. The Social Care Battleground
    Question:
    What will prevail? -Short term survivalism or long term sustainability.
    Answer:
    Organisations will need to work together in partnership and with innovation if we are going to meet the challenge to demonstrate that preventative services are more efficient in the long run
  • 37. What We Know & What We Need
    The Sustainability & Mainstreaming of Telecare depends upon the development of a national comprehensive care strategy that embeds telecare into health, housing and social care services
  • 38. What We Know & What We Need
    Pooled Health & Local Authority Budgets to
    Purchase telecare and telehealth equipment
    Integrated data collection & management
    Co-supervision of telecare and telehealth
  • 39. What We Know & What We Need
    National/Regional purchasing strategies with clear specifications to secure better products from suppliers
    A full-time professional in charge of Telecare / Telehealth regionally. With a level of authority and skills
  • 40. What We Know & What We Need
    Better and more consistent training for users, referrers and assessors
    Fully dedicated assessors
    Charging policies that remove perverse incentives – public/private funding strategy ?
    A Robust Business Case
  • 41. Why is Telehealth Delivery so low ?
    This presentation has concentrated on the supply side
    And the received wisdom is that we need get clinical involvement (esp. GPs) to work through telehealth
    Why aren’t clinicians flocking to it?
    Is it because health care is still too Hospital based>
    But is there a nightmare scenario that service user (patient) demand is low ?? – have we measured it?
    Is it that telecare is still too ‘cottage industry’ to help?
    Is it that Health & Social care are still not able to work together?
    Or is it just the stage we are at?
  • 42. Telecare in Wales
    Lee Davis
    Welsh Government
    07808 727466
    029 2080 1410
    Lee.Davis@Wales.GSI.gov.uk
    www.ssiacymru.org.uk/telecare