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

1. Reshaping Care
for Frail Older People in Scotland:
an Outcomes-Focussed Evaluation of
Telehealthcare in Falkirk
social work ... putting people first
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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
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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
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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)
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5. Major Health & Social Care Policy
Documents 2005-2011
Policy 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)
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6. Policy Analysis
The 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)
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7. Policy Analysis
To 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)]
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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 alternatives
2. assemble some evidence 6. adopt the policy
3. develop alternative solutions 7. implement, evaluate then improve the
policy implementation, disseminate
findings
4. identify the criteria used in the decision-
making framework
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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 policy
2. 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?
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10. Literature Review
Database 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
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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)
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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
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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
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14. Findings
Outcomes Key themes from
interviews with:
• Quality of Life Outcomes
• Change Outcomes • assessors
• Process Outcomes
• frail older service users
• informal carers
• technology providers
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15. Key Themes from Interviews
Assessors 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
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16. Key Themes from Interviews/continued
Informal 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
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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
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18. Key Insights from the Policy Analysis, the
Literature Review and the Empirical Work
2 main themes from the policy analysis:
1) Changing Lives (2006) emerged as a catalyst for change in the delivery of
health and social care services
2) the emergence of the reshaping care for older people agenda brought funding
to support service transformation
2 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
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19. Recommendations
At 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
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20. Recommendations
At 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
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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
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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
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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. Contact
Dr Gail MacNamara
tel: 01324 670223
mobile: 07730 952494
email: gail.macnamara@falkirk.gov.uk
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