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The mainstreaming of telehealthcare services will release substantial resources

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The mainstreaming of telehealthcare services will release substantial resources – how do you make it happen?

The mainstreaming of telehealthcare services will release substantial resources – how do you make it happen?

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  • Telehealthcare combines the best of telecare and telehealth technology to effectively and economically deliver care services in people’s homes, using solutions that can manage the risks associated with independent living. Haven’t just joined up the name, joined up the technology as well
  • Delayed discharges - between 7 and 15 days for each facilitated discharge saved Use of care homes : 50%+ were older people, telecare particularly successful at preventing or delaying admission for dementia
  • Talk here about how South Glos PCT (Orchard Medical Centre) developed a PbC service redesign business case that allowed them to receive 60k over 3 years from Takeda to improve patient care for HF patients and up skill practice nursing skills in heart failure and backfill time the practice nurses spent on implementing and developing telehealth care for heart failure patients
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    • 1. © 2008 Tunstall Group Ltd ConfidentialThe mainstreaming of telehealthcare services willrelease substantial resources– how do you make it happen?Doing More With Less !!
    • 2. 2© 2008 Tunstall Group LtdPresentation Team• Kevin Alderson– Public Sector Policy Director• Andrew Bailey– Account Director - Wales and the West Country
    • 3. 3© 2008 Tunstall Group LtdAreas to Cover• Taking stock– the Welsh Telecare programme has delivered a goodinfrastructure, it now needs building upon• Facing challenges– finances will be tight for the foreseeable future whilst demand forservices continues to grow through demographic trends• Maximising opportunities– this existing infrastructure can deliver big savings forredeployment if it is fully utilised• Key Objectives:-– Highlight the opportunity, through case studies– Illustrate the route to mainstream services, based on best practicein Wales and elsewhere– Discuss how to make this happen across Wales
    • 4. 4© 2008 Tunstall Group LtdTelehealthcare
    • 5. 5© 2008 Tunstall Group LtdFlexible telehealthcare solutionsMonitoring Centre can support:Administration duties,Emergency response coordinationLifestyle monitoringQuantify results,Coordinate installation and removal,Equipment inventoryValuable communication hub for thewhole serviceMonitoring CentreTelecare units andSensors in clients’homesResponse in theCommunityBased in client homesExtra care housingResidential housingNursing homes etc.Free phonetelephonenumber
    • 6. 6© 2008 Tunstall Group LtdFlexible telehealthcare solutionsMonitoring Centre can support:Administration duties,Non clinical triageQuantify results,Coordinate installation and removal,Infection controlEquipment inventoryValuable communication hub for thewhole serviceClinicians perform daily triage ofpatient caseloadMonitoring CentreTelehealth monitorsin patients’ homesClinicians,Community andTrust basedBased in patient homesExtra care housingResidential housingNursing homes etc.Free phonetelephonenumber
    • 7. 7© 2008 Tunstall Group LtdHow does Telehealthcare work?Telehealthcare delivery modelManaged ResponseSocial Care, Housing,Community Nursing,Friends, Family,Therapy, Meals,Voluntary Services…EmergencyResponseResponse CentreAlerts andReassuranceSocial care health care housing education
    • 8. 8© 2008 Tunstall Group LtdNURSINGSECURITYMEDICALPERSONALSOCIALENVIRON-MENTALSAFETYfire,floods,high temps,low temps,air quality,noise,hygienewandering,falls, CO gas,scalds,unburnt CH4,tampering,cooker/µwavemisuseincontinence,pressure areas,chronic disease symptoms,medication complianceIntruders,bogus callersdoor statususe of bed,little movement,bath monitor,lack of contact,poor nutritioncardiacarrhythmia,asthma attack,hypoglycemiaepilepticseizure,blockedcatheter,apnoeaContinuum of Telehealthcare Services
    • 9. © 2008 Tunstall Group Ltd ConfidentialEvidence of the positive impactsCitizens & PatientsCarersFinances
    • 10. © 2008 Tunstall Group Ltd ConfidentialWhat has been happening in Scotland?“JIT” (Joint Improvement Team)– Telecare Development Programme
    • 11. 11© 2008 Tunstall Group LtdQuality of life of users of telecare servicesTelecare’s impact on specific aspects likely to affect users’ quality of life?:• Over half (55.2%) of the respondents felt that their health had not changed,whilst slightly more than half of the other respondents (comprising 27.1% ofthe total) thought that their health had improved;• Almost all (93.3%) respondents felt safer;• Over two-thirds (69.7%) felt more independent;• Very few (3.5%) felt lonelier;• Four-fifths (82.3%) either “disagreed” or “strongly disagreed” that they feltmore anxious and stressed;• Most (87.2%) thought that their families now worried less about them;• About two-fifths (40.8%) felt that their equipment had not affected the amountof help they needed from their family, whilst about one-third (32.8%) felt thatthey needed less help.York Health Economics Consortium at York University/Scottish Government Final Evaluation Report, Jan 09http://www.jitscotland.org.uk/action-areas/telecare-in-scotland/telecare-publications/
    • 12. 12© 2008 Tunstall Group LtdReduced pressure on informal carers• Three-quarters (74.3%) of the respondents felt that telecare equipment has reducedthe pressures on them by reducing their stress levels• Fewer than one-in-twenty (4.3%) felt that their stress levels had increased;• Carers generally felt that the equipment gave them peace of mind as they worriedless (e.g. about falls);• They felt that people with learning disabilities could enjoy greater independence andthat the equipment could enable people with dementia to remain living in thecommunity for longer;• Even if stress levels had fallen, several respondents highlighted that caring can stillbe very demanding and stressful (especially if the client will not use their equipment);• However, many carers were very positive about the telecare service and also verygrateful for it.York Health Economics Consortium at York University/Scottish Government Final Evaluation Report, Jan 09http://www.jitscotland.org.uk/action-areas/telecare-in-scotland/telecare-publications/
    • 13. 13© 2008 Tunstall Group LtdTelecare in Scotland – prevention and efficiency!!Outcome Minimumtarget for2007-2010Actual achievedApr 07-Sep 07Actual savings achievedApr 07-Mar 08Est monetary savingHospital bed days saved by facilitatingspeedier hospital discharge46,500 1,800 5,668 days517 discharges£1.7m 15.5%Reduced unplanned hospital admissions -bed days savedInfo not avail Info not avail 13,870 days1220 admis£3.34m 30%Care home bed days saved by delayingpeople to enter care homes225,000 6,900 61,993 days518 admis£3.42m 30.7%Nights of sleepover care saved 46,000 1,250 Info not avail £0.55m 5%Home check visits saved 905,000 107,000 Info not avail £1.79m 6.1%Locally identified savings eg reduced wakingnightsInfo not avail Info not avail £0.30m 2.7%No. of TDP funded telecare users 13,505 6,005 7,902Estimated verifiable savings as a result ofScotland Telecare Dev Prog£43m £2.9m £11.15mYork Health Economics Consortium at York University/Scottish Government Final Evaluation Report, Jan 09http://www.jitscotland.org.uk/action-areas/telecare-in-scotland/telecare-publications/
    • 14. © 2008 Tunstall Group Ltd ConfidentialKey English Telecare Case StudiesNorth Yorkshire
    • 15. 15© 2008 Tunstall Group LtdNorth Yorkshire Cost Benefit AnalysisAverage 38% saving in care packages• The last 138 people assessed for telecare during the period of Sept 2008 wereanalysed. Some people were new to ACS and some were pre-existing with traditionalsupport• 7 cases were disregarded as outliers as it was felt they skewed the data toofavourably thus final total is 131 people analysed• Traditional packages were either the support that had previously been received (ifpre-existing case) or for support to new people was based on care manager’sprofessional assessment of need if Telecare had not been available.Service typeCount ofusersAnnualisedcost £TraditionalAve cost £annualisedcost £TelecareenhancedpackageAve cost £ Variance £% reductionin traditionalpackage £Aveefficiency£Residential care 60 784775.16 13079.59 417511.19 6958.52 355053.06 45% 5917.55CommunitySupport 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% 3654.51Traditional package Actual package of care used including Telecare
    • 16. 16© 2008 Tunstall Group LtdEvaluation Outcomes“Traditional” v “Telecare enhanced”• 46% of the traditional packages would have been residential, EMI or nursingand 54% at home• Those who would have had more than 10 hours home care saw a reductionin the number of hours needed• The trend for those who would have received 7 hours or less was areduction in the number of hours with some people needing no furthersupport• Analysis indicated a net average annual efficiency per person £3,654countywide• 38% reduction in care package costs.• Average of the sample (131) and grossing up for all those clients utilisingTelecare for over a year (330) gives net figure £1,108,609.
    • 17. 17© 2008 Tunstall Group LtdScrutiny Committee gives Telecaremainstreaming the green light – 2007In 2006/7 Care and Independence Overview and Scrutiny Committeeexamined the Implementation of Telecare in North Yorkshire. The report ofthe Chair of the Assistive Technology and Telecare Working Group 01/02/07concluded that:-• When Telecare has been implemented by authorities in a “big way” theevidence is the results can be quite startling, notably in terms ofreleasing hard pressed resources.• Telecare must not seen as an alternative to human contact, nor is it seen asan opportunity to police people. It is about supporting and managing risk,not about controlling behaviour.• Members concluded, to gain the greatest efficiencies with resources thatpreventative use prior to the service user becoming critical will derive themaximum gains for organisations, users and carers.
    • 18. 18© 2008 Tunstall Group LtdSatisfaction survey• A Directorate survey carried out in Spring 2008 which had 96 respondents indicatedthe 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.
    • 19. © 2008 Tunstall Group Ltd ConfidentialKey English Telecare Case StudiesStockton
    • 20. 20© 2008 Tunstall Group LtdEvidence ensures mainstreaming of serviceBACKGROUND• number of over 65s will increase by 46% by 2021• 20% of the population report having a limiting long term conditionOUTCOMES• A draft evaluation was taken to the Adult Care Partnership Board which showedthat overall savings were estimated to be £600,000 pa gross and £220,954pa net• The 13 month pilot directly supported the mainstreaming of telecare services inStockton• £400k funding over 2 years secured, £300k from PCT (local delivery planarrangement) and 100k social services (adult social care fund)• 270 people using telecare (defined as 2 or more pieces of equipment). Inaddition there are 4500 community alarm service users
    • 21. 21© 2008 Tunstall Group LtdReduction of care home/domiciliary care hoursEach telecare client receives a six week joint review and at the time of thisreport (May 2008), 90 reviews had been completed with social workprofessionals stating that:• 42 Telecare installations will delay care/residential care admission andeventually lead to a reduction in care home admissions. (47%)• 26 Telecare installations have resulted in stopping a care home admission.(29%)• 11 Telecare installations have resulted in no economic benefits. (12%)• 7 Telecare installations have resulted in reduced domiciliary care hours.(8%)• 4 Telecare installations have resulted in stopping nursing care homeadmissions. (4%)
    • 22. 22© 2008 Tunstall Group LtdHospital A&E attendance avoided/bed days savedThe key statistics when looking at this is the sensors detecting incidents early andmaking the service aware that there may be a problem.• This is highlighted by the main key incidents of sensor activity.– 64 Clients found on the floor.– 31 “Client Walking” activations where clients were found and returned safely to theirproperty.– Of these 95 incidents only 7 of the “clients on the floor” category led toambulances called and attending the hospitals accident and emergency services.• With Telecare staff attending the remaining call outs within an average of 14 ½ minutesfrom the time the incident has occurred it could be assumed due to the nature of theincidents the service has saved the local PCT:– 88 Ambulance call outs, in the region of £13,904 at an average £158 per call out.£158 is average cost of an ambulance call out.– £6,424 saving in A&E admission based on £73 per call average standard cost ofA&E admission. (PCT average Standard A&E admission)– £66,528 in bed days saved if each case had resulted in a 2 day hospital stay.Based on £378 per day hospital bed. (PCT average cost per day of hospital bed2008).
    • 23. © 2008 Tunstall Group Ltd ConfidentialKey English Telehealth Case Studies
    • 24. 24© 2008 Tunstall Group LtdNHS Blackpool and Vitaline• Delivering telehealth for over 3 years• COPD, HF, Diabetes, Partnership with Community Matrons• The PCT and Social services wrote up their findings and they havehad a:• 75% reduction in hospital admissions,• 48% reduction in home visits by community matrons,• 85% reduction in GP contacts.• Mainstream progression and expansion
    • 25. 25© 2008 Tunstall Group LtdNHS Blackpool and Vitaline – 12 month study
    • 26. 26© 2008 Tunstall Group LtdNHS Blackpool and Vitaline – 12 month study• 100% Equipment is easyto use• 80% Since having telehealthI understand my condition better• 80% I have less anxiety• 70% managing my conditionat home through telehealthhas enhanced my quality of life
    • 27. 27© 2008 Tunstall Group LtdOrchard Medical Centre – PbC project• Primary care (GP Practice) based (Orchard Medical Centre)• Led by GP’s, operationally run by district nursing and practice staff -Heart failurefocussed - Started March 07• PbC service change business case (Key outcomes and benefits trialled trialled)• Quality of life for patients improved• Increased knowledge and understanding of health promotion issues relating toheart failure, both by nursing staff and patients to troubleshoot problems andmake small changes that will impact on long term health.• Reduction in hospital admissions leading to a reduction in bed days demanded.• Reduction in hospital acquired infections and their complications by this frail andvulnerable group• Improved safety during complex medication alteration• Increased skills in the community and practice team• Increased skill mix in the combined team, with a further opportunity to workseamlessly in the primary care team• Pilot successful - now expanded and embedded into standard care within thepractice
    • 28. 28© 2008 Tunstall Group LtdImpact on Doctors TimeDoctor Use0123456MarchAprilMayJuneJulyAugSeptOctNovDecJan-08MonthcontactsperuserDoctor Tel CallsDoctor visitsDoctor in surgerytotal doctor demand
    • 29. 29© 2008 Tunstall Group Ltd“I’d be lostwithout telehealth”• Margaret has severe heart failureand would often forget to takemedication leading to regular visitsto A&E• She has not used out of hourshealth services at all in the lastyear• Telehealth gave Margaretincreased reassurance leading toimproved medication complianceand less visits to the hospitalCase study – OMC
    • 30. 30© 2008 Tunstall Group LtdExample large scale telehealth servicesWhole System Demonstrator• Tunstall is involved in all three WSD sites - Kent, Newham, Cornwall –covering 6,000 people• Cornwall: Major milestone achieved Aug 09 –over 2000 people taking part:– 1,100 telehealth patients– 1,100 telecare clients– Currently 1,100 in the control trial groupSuccesses• Now mainstream funded for 1,100 patients year on year (Expandinginto Stroke, Hypertension and UTI)• Effective internal service set up and project management• Dedicated administration and technical team• High awareness level and full clinical engagement– GP, Community Matrons, Medical physics, clinical team,and installation/de-installation team• Formal evaluation is currently underway with research institutes.
    • 31. 31© 2008 Tunstall Group LtdExample large scale telehealth servicesNHS North Yorkshire & York:• Mainstream funded – 2000 units (COPD, CHF, Diabetes, Stroke)• ROI based on reducing acute sector demand and improving operational efficienciesin primary care• Full service & care pathway redesign – embedding “care at home” services intostandard service provision.• GP, Case management and specialist clinical team critical to success - clinicalchampions in all key areas (geographical and specialist)• Full supporting service provision provided by Tunstall– Service desk (referral, commissioning, assessment and contact)– Single access sign on– Clinical consultancy– Project management– Outcomes evaluation
    • 32. 32© 2008 Tunstall Group LtdLarge scale Telehealth deployment &service redesign delivers a net ROI of 1.9• Indicative PCT of population 800,000• Total net savings of £9.1 million over 3 years• Annual net savings £5.1 million year 4 onwards• Net return on investment first three years 1.9• 2,000 patients (Heart Failure, COPD, Diabetes)– Telehealth technology supply: equipment packages, triage software, communicationfees, warranty/maintenance, consumables– Managed services: installations/de-installations, service desk, training– Care at Home Service redesign, LTC care pathway redesign and project support
    • 33. © 2008 Tunstall Group Ltd ConfidentialOverview of integrated telehealthcareserviceICPIntegrated Care Platform
    • 34. 34© 2008 Tunstall Group LtdICPIntegrated Care PlatformIdentifyPatients &conditionServiceManagementSelf Care &MonitoringData Capture& ProcessingClinicalDecisionSupport Coaching &Educationpatient
    • 35. 35© 2008 Tunstall Group LtdManaged Services that support caredelivery transformationIdentifyPatients &conditionServiceManagementSelf Care &MonitoringData Capture& ProcessingClinicalDecisionSupportpatientCoaching &EducationTransforming CareDeliveryService andPathway re-design
    • 36. 36© 2008 Tunstall Group Ltd36ICP: Provide the building blocks….IdentifyPatient& NeedsServiceManagementSelf Care &MonitoringDataCapture& ValidationClinicalDecisionSupportCoaching &EducationTelecoachingHealth informationPatient PortalVideo ConferencepatientHealth SurveysSecureCommunicationsN3 HostingTechnical TriageClinical TriageRiskstratificationHealthcareportalPatient ReferralService Desk
    • 37. 37© 2008 Tunstall Group LtdTunstall Service DeskPlatformTunstalltelehealthplatform2 way flow of patient detailsPatients/CarersServicesupport staffOnline Referral FormReferring cliniciansMultiple referral sourcesCommunication coordinationTrust staffOther H&SCplatformsSystem IntegrationSLA ReportsTunstalltelecareplatformIntegrated telehealthcare delivery……joining up health & social careN3environmentLocally hosted
    • 38. 38© 2008 Tunstall Group LtdHow does Telehealthcare work?Telehealthcare delivery modelManaged ResponseSocial Care, Housing,Community Nursing,Friends, Family,Therapy, Meals,Voluntary Services…EmergencyResponseResponse CentreAlerts andReassuranceSocial care health care housing education
    • 39. © 2008 Tunstall Group Ltd ConfidentialWhat are the barriers to making thishappen?How do we make “mainstream” happen?Discussion session
    • 40. © 2008 Tunstall Group Ltd ConfidentialThank you for listeningkevin.alderson@tunstall.co.uk07740 578000