Outcomes from Telecare and Advanced Assistive Technology – Two Years of Progress Welcome

1. Outcomes from Telecare and Advanced Assistive Technology – Two Years of Progress Welcome

2. Telecare Commissioning - Agenda • ‘Building Telecare in England’ (July 2005) and PT Grant (from April 2006) • White Paper - ‘Our health, our care, our say’ (January 2006) -demonstrators – Cornwall, Newham, Kent • Putting People First Concordat (December 2007) • Prime Minister’s Statement on the NHS (January 2008) • Transforming Social Care – LAC (2008)1 (January 2008) • PT Grant carry over to 2008/9, Supporting People and other funding • Joint Strategic Needs Assessment, Local Area Agreements • Integrated and partnership working including pooled funds • Demographic factors and demand forecasting, use of predictive models • World class commissioning, whole systems approaches • Better procurement, performance management and value for money • Telecare and telehealth as mainstream service options • User choice and independence through direct payments, personal budgets, self care and self assessment, preventative services • Standards – interoperability, connectivity, electronic health records • Workforce design, education and training

3. Section 3.3 “…… Person centred planning and self directed support to become mainstream and define individually tailored support packages. Telecare to be viewed as integral not marginal……” December 2007

4. Challenges for commissioners and providers • Whole population not solely those with identified needs (JSNA and LAA) • Embedding telecare in care pathways, commissioning documents, specifications and contracts • Choice, options and capacity in the marketplace • Independent advice, guidance and brokerage • Transforming community equipment/retail model • Added value eg enhanced home care • Marketing services directly to users and carers • Costing and charging, amounts transferred into personal budgets

5. “….So over the next few years we will give 100,000 people with long-term conditions the opportunity to manage their care in this way as 'expert patients'. And during 2008 we will bring forward a patients' prospectus that sets out how we will extend to all 15 million patients with a chronic or long-term condition access to a choice of 'active patient' or 'care at home' options -- clinically appropriate to them and supported by the NHS. Real control and power for patients - supported by clinicians and carers. More than today's new choice of where and when you are treated, a new choice tomorrow - in partnership with your clinician - about your treatment itself. Something made even more accessible by using NHS direct, the internet and digital TV as well as the telephone to improve support for patients who want an active part in their care…..” Gordon Brown, Prime Minister, January 2008

6. Transforming Social Care LAC (2008)1 – references to telecare 11…….Assistive technology such as telecare and minor adaptations, like fitting a handrail, can also enable people with support needs to continue to live in their own homes…… 17 With self-directed support, people are able to design the support or care arrangements that best suit their specific needs. It puts people in the centre of the planning process, and recognises that they are best placed to understand their own needs and how to meet them. They will be able to control or direct the flexible use of resources (where they wish to), building on the support of technology (eg telecare), family, friends and the wider community to enable them to enjoy their position as citizens within their communities…… 10 …..Person centred planning and self-directed support to become mainstream, with individuals having choice and control over how best to meet their needs, including through routine access to telecare…..

7. Telecare Commissioning - Challenges • Human contact and technology, ethical and consent issues – eg organisations are used to commissioning intensive home care but not linked with telecare, extra care or LTC management • Savings may accrue in health from a local authority investment • Local authorities and their partners fail to plan for telecare and telehealth beyond March 2008 when the PT Grant funding ends (JSNA and LAA) • Poor engagement with users, carers, GPs, third sector and other key stakeholders – decisions are made beyond the influence of main beneficiaries • Inconclusive benefits for investments made, charging, business case • Funding leakage and diversion with fragmented services and poor uptake • Focus on outcomes as well as inputs/outputs • Product and service innovation – design improvements • Questions about the evidence base, problems with referrals • Lack of a culture of joint/integrated/strategic commissioning across service organisations leads to poor decisions made in isolation which are not linked to best outcomes

8. Telecare Commissioning – Evidence of progress • CSCI – survey information from 2006 and 2007 with further coverage in 2008 • 150 Telecare profiles updated – December 2007 • NHS PASA framework – further updates from April 2008 • Five events covering outcomes, achievements and challenges – qualitative information about progress • Better understanding of the best care pathways and the importance of preventative as well as reactive approaches • White Paper LTC Demonstrator Sites commence – Spring 2008 • Assisted Living Innovation Platform (ALIP) commenced Nov 2007 - part of the work of the Technology Strategy Board • Headline issues on safer walking devices, home monitoring • References in key policy documents • Telecare on BBC Radio 4 ‘You and Yours’ on 30 January 2008, Ivan Lewis on 31 January 2008 • Academic reports, evaluations, journals • Major conferences featuring telecare/telehealth • Wider initiatives on interoperability, standards, consumer products • Major global companies, expansion in Europe, North America etc

9. Achievements of the National Framework Agreement since June 2006 Since the Telecare National Framework Agreement was launched in June 2006, it has: • Helped support the implementation of telecare and telehealth across the UK. £32m worth of UK-wide spend (up to 30 Nov 07) has been channelled through the agreement • 80%+ of Local Authorities in England are actively using the NFA • Generated cash releasing savings of £7.4m (up to 31 Oct 07) • Reduced the lead time and cost to the public sector bodies undertaking their own local tendering process to procure equipment and services (efficiency savings in the region of £27m to the UK public sector) • Increased access to new technology and innovation offered by the wide range of suppliers participating in the agreement. NFA product offerings updated on an annual basis via review process with NFA participating suppliers • Won the Chartered Institute of Purchasing and Supply Best Public Procurement Project Award in September 2007

10. Telecare performance “…The (Preventative Technology) grant should be used to increase the numbers of people who benefit from telecare, by at least 160,000 older people nationally…. ….Through the grant, the Department expects councils to invest in telecare to help support individuals in the community. This aims to help an additional 160,000 older people to live at home with safety and security and reduce the number of avoidable admissions to residential/nursing care and hospital….” Building Telecare in England, Department of Health, 2005 – Additional users benefiting from telecare

11. Telecare performance • The first collection of local data was carried out by CSCI in April 2006 • The aim was to: • Identify baseline figures at March/April 2006 • Identify projections of additional users and equipment/infrastructure expenditure for 2006/7 and 2007/8 • Obtain a summary of the proposed scope of the telecare service • A profile has been developed for each of the 150 social care authorities based on the 2006 information. These profiles, were updated in December 2007.

12. Telecare performance

13. Telecare performance

14. Telecare performance

15. Telecare performance

16. Telecare performance – 2008 provisional • Outturns – numbers/expenditure • Projections for 2008/9 • Question – outcomes • Question - mainstreaming and sustainability

17. Performance and support HEALTH “…… Person centred planning and self directed support to become mainstream and define individually tailored support packages. Telecare to be viewed as integral not marginal……” PPF Section 3.3 Third sector and others Social Care Housing

18. In your area, how many people…… Telecare Commissioning - Agenda Have dementia? Fell at home in the last week? Have a long term neurological condition? Have angina, heart failure, diabetes? Live alone with poor housing at risk of crime? Have intensive home care, COPD and depression? Attend A&E regularly? Could be in a care home in the next year? Could benefit from preventative support? Could benefit from integrated telecare/telehealth services?

19. LTC model, social care and housing Health care (vulnerable) More complex cases Accessible Health & social care Information/advice

20. LTC model, social care and housing FACS Critical Substantial Social care (vulnerable) Moderate Low

21. LTC model, social care and housing FACS Critical Substantial Social care (vulnerable) Health care (vulnerable) Moderate More complex cases Low Accessible Health & social care Information/advice

22. LTC model, social care and housing FACS Critical Substantial Social care (vulnerable) Health care (vulnerable) Data sharing/Degree of integration Moderate More complex cases Low Accessible Health & social care Information/advice

23. LTC model, social care and housing Extra Care FACS FACS Hospital discharges Critical Heart failure/ECG Dementia COPD, diabetes Substantial Social care (vulnerable) Health care (vulnerable) Disease Mgmt Moderate LD Falls, medication More complex cases Low Supporting People Accessible Health & social care Information/advice Examples of current telecare supported care pathways

24. LTC model, social care and housing FACS Critical Substantial Single assessment Contact Overview Specialist Comprehensive Social care (vulnerable) Health care (vulnerable) Moderate More complex cases Low Accessible Health & social care Information/advice Commissioning Approach - reactive, responsive to highest needs?

25. LTC model, social care and housing FACS Critical Substantial Single assessment Contact Overview Specialist Comprehensive Social care (vulnerable) Health care (vulnerable) Moderate More complex cases Low Accessible Health & social care Information/advice Commissioning approach – preventative and self care stops people moving into critical/substantial and into hospital

26. LTC model, social care and housing FACS Critical Substantial Single assessment Contact Overview Specialist Comprehensive Social care (vulnerable) Health care (vulnerable) Moderate More complex cases Low Accessible Health & social care Information/advice Commissioning approach - all users where needs could be met by telecare? Cost?

27. Two years of progress

28. Housing & Telecare Networks Care Services Improvement Partnership Department of Health Wellington House 135-155 Waterloo Road London SE1 8UG e-mail: telecare@csip.org.uk Website: www.icn.csip.org.uk/telecare