Reshaping Care for Frail Older People in Scotland (WS34)

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Falkirk Council – Reshaping Care for Frail Older People in Scotland: an outcomes focused evaluation of Telehealthcare in Falkirk. Contributor: Falkirk Council

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  • Two of the researchers from the University of Glasgow continued this work with the Scottish Government Joint Improvement Team (JIT) where the UDSET was piloted, developed and re-named as Talking Points (Miller and Cook, 2011). The conversational approach to assessment is described by Miller and Cook (2011, p.2) where they highlight that the ability to listen, and to build a relationship with the interviewee is a necessity in “ outcomes-focused work ” . The principles of Talking Points (Miller and Cook, 2009 & 2011), underpins all aspects of this research study (i.e. the design of the peer-reviewed interview questions, the conversational approach to one-to-one interviews and the presentation of data from the interviews).
  • Transformational change is a policy objective that is necessary if the delivery of health and social care services is to change. The policy agenda recommends that transformational change is required to shift the balance of care and reshape care, and advocates that CHPs on behalf of the local Health Boards have this responsibility (Changing Lives, 2006). Transformational change is defined as: “ change, in which there is a fundamental change in the strategic direction ” (Johnson et al, 2005, p.27). At this time in Scotland change is not transformational. There are pockets of successful change Technology solutions are expanding rapidly. The public need to be aware of the available technology and what it can do to keep people (not just frail older people) safe in their homes and allow them to live as independently as possible while giving their families peace of mind.
  • Reshaping Care for Frail Older People in Scotland (WS34)

    1. 1. Reshaping Care for Frail Older People in Scotland:an Outcomes-Focussed Evaluation of Telehealthcare in Falkirk social work ... putting people first 1
    2. 2. Content• the research project• evaluation research• the major health and social care policy documents in Scotland 2005-2011• analysis of the Scottish Government policy (the framework)• the literature review• telehealthcare• methodology/method• findings (e.g. outcomes/key themes/corresponding themes)• recommendations at a local level/at Scottish Government level• summary 2
    3. 3. The Research Project• in partial completion of a post graduate degree (Professional Doctorate) undertaken at Glasgow Caledonian University• resource and time limited – therefore it is ‘a glimpse’ a small- scale evaluation• this evaluation is unique in that 4 diverse groups of participants were interviewed, with the research study underpinned by a personal outcomes approach 3
    4. 4. Evaluation Research• this evaluation served as a lens to examine the experiences and opinions of the participants regarding telehealthcare• in modern health and social care it is unethical to avoid or be ignorant of evaluation (Ovretveit 1997)• evaluation is always carried out in changing times• evaluation is not merely associated with assessing worth or value but with looking to improve the service Robson (2003) 4
    5. 5. Major Health & Social Care Policy Documents 2005-2011Policy Analysis – the policy documents evaluated were Scottish Government • Report of the 21st Century Social Work Health & Social Care policy Review (2006) (Changing Lives) documents 2005-2011: • Co-ordinated, integrated and fit for purpose: A Framework for Adult• A National Framework for Service Rehabilitation in Scotland (2007) Change in the NHS in Scotland: (Rehab Framework) Building a Health Service Fit for the • Better Health, Better Care, Action Plan Future (2005) (the Kerr Report) (2008)• Delivering for Heath (2005) • A Force for Improvement (2009)• Better Outcomes for Older People • Reshaping Care for Older People: A (2005) Programme for change 2011-2021• Delivering care, enabling health (2010) (Reshaping Care) (2005) • Review of Community Health• Developing Community Hospitals: a Partnerships, Audit Scotland (2011) Strategy in Scotland (2006) 5
    6. 6. Policy AnalysisThe characteristics generating theory and affecting policy analysis in the research study:• high profile issues (e.g. demographics, workforce capacity, budget resource, rapidly expanding technology solutions)• key stakeholder involvement (e.g. service users, informal carers, assessors, technology providers)• professionals/practitioners (e.g. hospital staff, GPs, DNs, AHPs, pharmacists and the social service workforce)• local authority officers (e.g. policy planners, finance and human resources)• government ministers and civil servants• regulators/scrutiny bodies and strategic groups that oversee the quality of care delivered (e.g. SSSC, Care Inspectorate, CHPs, NHS Boards, COSLA, ADSW, IRISS and Trade Unions) 6
    7. 7. Policy AnalysisTo undertake an analysis of the health and social care policy in Scotland a systematic theoretical framework was required:• Framework: policy analysis for frail older people in Scotland (MacNamara 2012)[adapted by MacNamara from Bardach (2005) and Weiner (2005)] 7
    8. 8. MacNamara (2012) Policy Analysis for Frail Older People in Scotland adapted from Bardach (2005) & Weiner (2005)Action:1. understand and define the problem 5. impact of the policy alternatives2. assemble some evidence 6. adopt the policy3. develop alternative solutions 7. implement, evaluate then improve the policy implementation, disseminate findings4. identify the criteria used in the decision- making framework 8
    9. 9. The Policy Analysis Framework (MacNamara 2012) adapted from Bardach (2005) & Weiner (2005)1. has the history of health & social care 6. were groups of key stakeholders formed to policy in Scotland/the scope & magnitude implement new policies? (e.g. steering of the changing demographics/key groups). Were further changes considered stakeholder/expert involvement & following monitoring? consultation been considered/happened 7. has there been an evaluation? Has the policy2. is their evidence of previous been revised? Were successes disseminated policy/implementation supporting at a local level/to the extended services & successes? community/nationally?3. is their evidence of transformational change? (e.g. a shift in the balance of care/reshaping of care)4. have the personal outcomes for frail older people and their informal carers been considered/have fairness & equity been ensured?5. has multidisciplinary expert opinion been considered? Who will fund/carry out services if change does not happen? 9
    10. 10. Literature ReviewDatabase Search/Professional Journals/Scottish Government Websites/Professional Journals/References in article sourced hand-searched/Grey Literature hand-searched• previous research studies• views of health and social work professionals regarding telehealthcare• views of frail older people regarding telehealthcare• the management of falls• risk factors and managing risk• unplanned hospital admission• delayed discharge/premature discharge• complementary services• CHPs/breaking down barriers/delivering a seamless service• the capacity of the workforce• culture change• the assessment process• local demographics• telehealthcare 10
    11. 11. Telehealthcare at a Local Level Mobile Emergency Care Service (MECS) and Telehealthcare in Falkirk• following an initial award of monies from the Scottish Government the MECS evolved from the basic community alarm to a comprehensive MECS/Telehealthcare service• The MECS provided a solid infrastructure and a platform to allow development of existing services and the introduction of new and innovative aspects• the Telecare Development Programme – this monetary resource allowed the MECS Team Manager protected time to develop the telehealthcare service• a submission was made to the Change Fund in early 2012 to allow the MECS team to expand (MECS/Telehealthcare) 11
    12. 12. Methodology• a qualitative methodology - a summative or outcomes evaluation that captures the impact of the service• the effectiveness of the service is considered (outcomes can feed into future funding decisions and/or increase the body of knowledge)• a personal outcomes approach ((Miller and Cook, 2007/2009/2011) underpinned the design of the interview schedule for service users, informal carers, assessors and technology providers, the conversational approach to the interviews and the presentation of the findings/outcomes 12
    13. 13. Method• research integrity• principles & responsibilities• rigour, quality, reliability and validity• reflexivity• ethics application and approval• sampling strategy/recruiting/contacting• interview process/recording data/analytical process• outcomes – key themes/corresponding themes 13
    14. 14. FindingsOutcomes Key themes from interviews with:• Quality of Life Outcomes• Change Outcomes • assessors• Process Outcomes • frail older service users • informal carers • technology providers 14
    15. 15. Key Themes from InterviewsAssessors Service Users• falls linked to telehealthcare • feeling safe/worrying less• the need for a culture change and awareness • accepting telehealthcare raising • the telehealthcare response process• prevention of unplanned admission to • remaining independent and getting out and hospital/care home/facilitating discharge about• peace of mind for service users • ongoing face-to-face contact• barriers/challenges/drivers to implementing • enabled to remain living at home a telehealthcare service • benefits• referrals and the gap in the assessment • improved confidence/moral process • improved health/mobility/support to reduce symptoms • being listened to/treated with respect • time given to discuss/accept/decline telehealthcare • response process/reliability 15
    16. 16. Key Themes from Interviews/continuedInformal Carers Technology Providers• improved health and wellbeing / • advice/expertise reduced risk • acceptance of telehealthcare• carer time to work/socialise/undertake • motivated service users hobbies • Scottish Government policy agenda• coping with the caring process • designing telecare equipment to meet• enabled to continue caring assessed need• knowing who to contact/involved in • Falkirk’s profile in Telehealthcare in the process Scotland• included in the assessment process• opinion valued, staff flexible and responsive to changing need 16
    17. 17. Corresponding Key Themes from the 4 Participating Groups• telehealthcare offers peace of mind, with reduced anxieties for service users/informal carers/families• falls prevention is linked to telehealthcare. Having technology solutions in place allows frail older people to remain living in their own homes with the knowledge that if they fall, they can summon assistance quickly• a culture shift is required within health and social services to encourage new ways of working and allow telehealthcare to be further accepted/developed• awareness raising regarding not only telehealthcare but the reshaping care agenda for frail older people is required within health and social care services and across key stakeholders and the general public• telehealthcare enables service users to remain living at home independently, while preventing unplanned admission to acute hospital services and it supports speedier discharge 17
    18. 18. Key Insights from the Policy Analysis, the Literature Review and the Empirical Work2 main themes from the policy analysis:1) Changing Lives (2006) emerged as a catalyst for change in the delivery of health and social care services2) the emergence of the reshaping care for older people agenda brought funding to support service transformation2 main themes from the literature review:• assessment of and management of risk have a bearing on the success of telehealthcare service implementation• telehealthcare can stand alone or be supported and/or complemented by homecare, falls management, reablement or by equipment and adaptations 18
    19. 19. RecommendationsAt a Local Level:• a culture change is necessary within health and social care• an outcomes-focussed SSA for telehealthcare• a dedicated team to assess and prescribe telehealthcare• a reablement approach to care can be complemented by telehealthcare – raise awareness!• awareness raising regarding telehealthcare across the health and social care partnership and in the public arena 19
    20. 20. RecommendationsAt Scottish Government Level:• Support required to enhance and improve communication and sharing of information within local partnerships and with partnerships across Scotland• a ‘change management’ approach is required to implement transformational change• more awareness raising regarding telehealthcare in the public arena is required, to change public perception and to share knowledge 20
    21. 21. What Next?• a culture of evaluation needs to be embedded in all health and social care service delivery• evaluate telehealthcare in other services (e.g. physically disabled/learning disability/children’s services/dementia)• use the personal outcomes approach to underpin empirical work 21
    22. 22. In Summary• prior to the publication of health and social care policy in Scotland (2005-2011) there was extensive consultation• the telehealthcare service in Falkirk meets the personal outcomes required by the frail older people /informal carers interviewed –the outcomes charts• frail older people and their informal carers feel safe living at home supported by telehealthcare and have peace of mind• telehealthcare has been used successfully in Housing with Care in Falkirk to support frail older service users to remain living at home• moving on - Falkirk has already moved forward. My colleague Linda Saunders Team Manager MECS & Telehealthcare will take questions/ have a discussion with you 22
    23. 23. References• Bardach, E. 2005, A Practical Guide for Policy Analysis: The Eightfold Path to More Effective Problem Solving, Second Edition, CQ Press Washington• Ovretveit, J. 1997, “Evaluating Interprofessional Working – a Case Study Example of a Community Mental Health Team” in: Interprofessional Working for Health and Social Care, ed J. Ovretveit, P. Mathias, T. Thompson, MacMillan: Hampshire, pp. 52-78• Robson, C. 2003, Real World Research: A Resource for Social Sciences and Practitioner- Researchers 2nd edn, Blackwell Publishing Ltd, Oxford• Weiner, J. 2005, Health Policy Checklist for the Development, Selection and Assessment of Program Policies Within Health Care Organizations, [online] Available at: http://ocw.jhsph.edu/courses/introhealthpolicy/PDFS/Bardach_Outline_IHP_7b.pdf [Accessed] 14/12/2011• Miller, E. Cook, A. 2007, Users and Carers Define Effective Partnerships in Health and Social Care [online] Available at: www.jitscotland.org.uk/action-areas/themes/involvement [Accessed 05/10/2011]• Miller, E. Cook, A. 2009, Talking Points: A Personal Outcomes Approach, Support Pack for Staff, Focusing on the outcomes important to users and carers [online] Available at: http://www.jitscotland.org.uk/action-areas/talking-points-user-and-carer-involvemen/staff- development-and-leadership-materials/• [Accessed 05/01/2010]• Miller, E. Cook, A. 2011, Key Messages, Talking Points: Personal Outcomes Approach [online] Available at: http://www.jitscotland.org.uk/action-areas/talking-points-user-and-carer- 23 involvement/background-1/ [Accessed 22/12/2011]
    24. 24. Contact Dr Gail MacNamara tel: 01324 670223 mobile: 07730 952494email: gail.macnamara@falkirk.gov.uk 24

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