About the research

1. Integrating stakeholder needs with telecare service development. Lessons from the UKJames Barlow1Hazel Aldred2Steffen Bayer1Simon Brownsell2Richard Curry1Mark Hawley21 Tanaka Business School, Imperial College London2 Barnsley Hospital NHS Foundation Trust

2. About the research Evaluation of factors triggering increasing levels of care Evaluation of relationship between trigger factors and indicators of quality of life Research on perceptions and attitudes towards telecare (not discussed in this poster) Literature review: 158 papers included Literature review: 24 papers included 22 focus groups (170 older people, carers, care profs) Workshop with care service stakeholders to prioritise the trigger factors Indication of individual attitudes and interest in telecare Mapping identified trigger factors / QOL indicators against formal care services and telecare technologies Simulation modelling to explore resource implications at local care system level Provides pointers to help prioritise telecare services but planners also need to consider resource implications Indication of generic user needs and factors influencing increased care provision that telecare could address • 2 Research objectives • Our research aims to show how detailed user needs analysiscoupled with simulation modelling can inform telecare policy and investment decisions. • The background to the research is the government’s current programme to extend the use of telecare to support older people within their own homes. • Around £80m is being made available to pump prime new telecare schemes from April 2006. However, policy makers and care managers need clarity over which user groups and services should be prioritised. • 1Background • Policy makers and health professionals are seeking to develop innovative approaches to the delivery of care services for older people and those with chronic conditions. These include an increased emphasis on the delivery of care in new settings – such as in intermediate care facilities and the patients’ own home – and the use of information and communications technologies (ICT) to support care delivery through telecare. • Providing older and disabled people with increased independence is a major element of the UK’s care policy agenda. The use of telecare to maintain people’s quality of life has been widely discussed and since 1998 at least a dozen government reports have argued for its introduction. There are now ambitious targets for full telecare coverage by 2010. • The poster draws on research from two major studies on the implementation of telecare aimed at maintaining older people’s independence. • One study explored the needs of the various stakeholders – end users and a range of care providers – likely to be involved in the provision of telecare services. • The second study is using systems dynamics and other modelling approaches to investigate how telecare impacts on patient flows and costs and benefits within a local care system. Connections between elements of the research

3. What is telecare and what can it do? • We define telemedicineas ICT based applications which support the exchange of information between health care professionals, generally for diagnosis or referral. • This distinction between telecare and telemedicineis important because the latter is inherently simpler to implement since it focuses on specific applications (e.g. teledermatology, teleoncology) and involves fewer stakeholders from different parts of the care system. Safety and security monitoring, e.g. bath overflowing, unlit gas left on, door unlocked Mitigating risk Prevention The individual in their home or wider environment Information & communication, e.g. health advice, triage, access to self-help groups • Personal monitoring: • physiological signs • activities of daily living Prevention Improving functionality Electronic assistive technology, e.g. environmental controls, doors opening/closing, control of beds Potential benefits to care system stakeholders • 3 What is telecare? • ‘Telecare’, ‘telehealth’, ‘telemonitoring’ and ‘telemedicine’ are used interchangeably to describe the remote delivery of health and social care. • We define telecare as a set of services bringing health and social care directly to the end-user. • Telecare is based on the premise that people in need of care should be able to participate in the community as much as, and for as long as, possible. • Three bundles of telecare services can be identified: • safety and security monitoring • personal monitoring (physiological and activity) • informationprovision • Data from the use of electronic assistive technology – designed to provide the occupant with greater functionality in the home – could also be integrated into activity monitoring to provide more information on how individuals are coping. • Some telecare systems provide a response to an immediate need, for example a fall or a sudden change in an individual’s vital signs. • Other systems can provide evidence of changes to an individual’s health and social care status, and could therefore contribute to an individual’s chronic disease management programme.

4. Understanding user needs • 4 Identifying trigger factors • The literature review identified 102 factors triggering greater amounts of care and support for older people. However, there appeared to be no ranking in terms of priority, making it hard for planners and policy makers to target resources where the greatest returns may be observed. • To prioritise the trigger factors, a workshop was held with participants from a range of relevant agencies such as health and social care, housing and voluntary services. The participants identified a further five trigger factors. • All 107 trigger factors were randomly ordered and prioritised by the participants. A total of 36 were identified as being in the top three bands of importance. • 5 Mapping trigger factors against telecare • The role of formal care services and current or emerging telecare (and other electronic assistive technology or EAT) in addressing or mitigating each of the 36 trigger factors was examined through a further literature review and consultation with healthcare professionals and other experts. • Twenty-nine (81%) of the trigger factors are addressed by formal care services • Twenty-three (64%) can be addressed by current telecare / EAT technology and an additional eight (22%) by emerging technology. • Twenty-one (58%) of the trigger factors fall within the domains of formal care services and current or emerging telecare, suggesting that while it has a role to play, the support of formal care services is required in combination with telecare.

5. Trigger factors, telecare and quality of life • 6 Trigger factors and quality of life issues • A literature review was conducted to identify factors commonly accepted as issues relating to quality of life. • For 33 of the 36 trigger factors there is a corresponding relationship with QOL issues. For the others this does not necessarily mean that there is no link, but rather no reference was observed in the QOL literature review. • This demonstrates how telecare, by addressing key trigger factors, also has the potential to positively impact on quality of life issues. • However, further work is required to validate these findings and to identify at what point specific types of telecare technology should be implemented against a certain trigger factor. • In addition, the multiple interplay of trigger factors needs to be better understood.

6. Planning new telecare services • 7 Service development decisions • Exploring how telecare can address broad, generic user needs at the individual level helps give care providers pointers to where telecare interventions should be targeted. • However, planning new services needs to take into account their wider impact and resource implications across the health and social care system. • The cost of establishing and operating a telecare service depends on two key decisions: on its scale (the number and type of people to be supported) and scope (level of benefits to patients), and on the procurement route (e.g. ‘in-house’ or via a third party). • An understanding of the implementation, capital and operational costs of each option over time is needed in order to inform more detailed decisions about financing options. • This may be complicated by the system wide costs and benefits falling across different budget streams in health and social care provision. • 8 Simulation modelling • Simulation modelling can help organisations developing telecare services refine their initial decisions by providing guidance on their implications for care system resources and costs over time. • The use of a dynamic approach (system dynamics modelling) is particularly appropriate since level of scale and scope of service, and whatever procurement route is chosen, the effects of telecare will not be instantaneous. • In previous work we have used this approach to investigate the effects of telecare on the care system over time based on national data and the estimates of the effect of telecare on an aggregate user groups. • Based on the research on trigger factors reported here and data from trials to be carried out later in 2005 we will be able to carry this work forward distinguishing different types of telecare and their impact on the care system. Example: impact of telecare for frail elderly people under differing assumptions about effects on progression of frailty and rate of telecare service implementation

7. Key findings and conclusions Acknowledgements The poster draws on research funded by the Engineering and Physical Science Research Council (grant nos. GR/S29058/01 and GR/N31320/02). The research was carried out collaboratively by Imperial College London, University College London, Dundee University and Barnsley Hospital NHS Foundation Trust. Further reading Aldred, H.; Barlow, J;. Brownsell, S;. Curry, R.; Hawley, M. Gerontechnology. Meeting whose need? 5th International Conference of the Society for Gerontechnology, 24-27 May 2005, Nagoya, Japan. Barlow, J.; Bayer, S.; Castleton, B.; Curry, R. Meeting government objectives for telecare in moving from local implementation to mainstream services. Journal of Telemedicine and Telecare, 2005, 11, S1. Bayer, S.; Barlow, J.; Curry, R. Assessing the impact of a care innovation: telecare. 22nd International Conference of The System Dynamics Society, 25-29 July 2004, Oxford. Brownsell, S.; Aldred, H.; Hawley, M. (2005) The role of technology in addressing the care and support needs of older people. 5th International Conference of the Society for Gerontechnology, 24-27 May 2005, Nagoya, Japan. Brownsell, S. et al (2001) An attributable cost model for a telecare system using advanced community alarms. Journal of Telemedicine and Telecare, 2001, 7: 63-72. • 9Key findings • We conducted a detailed evaluation of factors triggering increasing levels of care and their relationship with indicators of quality of life. • We mapped these against available and emerging telecare services and related assistive technologies. • Together, this allowed us to develop a perspective on the individual user needs where telecare could help to maintain independence and quality of life. • This can provide an indication of generic user needs that could be addressed through telecare. Simulation modelling can help to answer questions about where to target and how much to charge for services. • 10Conclusions • To meet government aspirations for mainstreaming telecare it is vital to identify areas where it is likely to deliver the greatest benefit. Policy makers and care providers need to make investment decisions on the basis of sound evidence for the impact of telecare at the individual and care system level. • Research on the links between user needs, quality of life and factors triggering increased levels of care provides a baseline to inform the development of new telecare services. Simulation modelling is needed to explore their wider impact.