LONDON TELECARE SERVICES GROUP Developing aTelecare Evaluation Framework Dr. Kevin Doughty Joseph Rowntree Foundation

2. Background PTG available from April 2006 � awarded to Social Services Departments in England to help maintain 80,000 additional people independent in the community through use of technology i.e. telecare Telecare redefined to include: Electronic assistive devices such as reminders Alarm systems linked to monitoring centres Remote vital signs and ADL monitoring systems Information, advice and video conferencing systems Grant not ring-fenced nor subject to tight guide-lines Money may be used to support non-telecare services Telecare services may vary significantly in quality and form Future funding for health and social care may be dependent on the successful implementation of telecare There is a pressing need to provide evidence for the success of telecare in helping to achieve some or all of the improved outcomes suggested by the Audit Commission reports The quality of this evidence needs to be good and in as standard a form as possible in ordere to maximise the impact

3. Goals of Evaluation Cook & Hussey (2002) identified four basic aims for the evaluation of a new service: Effectiveness in achieving the desired outcomes What are the aims from the end user perspective? What does the commissioner expect? The efficacy of the service elements Did the kit do exactly what it was supposed to do? Was the service safe and well delivered? The availability of the service to end users Is the service being offered to the right people? Are they getting it at the right time (i.e. when needed)? The efficiency (by cost) of service delivery What is the cost of delivering the service? What are the financial savings to the system? How much are end-users contributing to the cost?

4. Desired Outcomes Public Sector Reduced admissions to residential care Reduced voids in sheltered housing Reduced unplanned hospital admissions/readmissions Reduced DeToCs Reduced demand for other council services Reduced emergency ambulance & A&E needs Improved assessments Increased system capacity Individuals Increased choice in location and type of care More responsive services Improved Quality of Life Increased independence Increased opportunity to �stay put� Reduced carer stress Reduced care costs (protection of inheritance for kids) Greater sense of satisfaction for professional staff

7. Service User: Impact & Outcomes

8. Service User: Quality of Life

9. The Carer Perspective

10. What About the Workers? The introduction of telecare can have a major effect on the day-to-day work of health, housing & social care staff � it will undoubtedly be disruptive The opinions of staff on the technology will depend on how it was explained to them, the level of training that they have received, and their attitude towards technology Their opinions need to be sought at an early stage so that: They enthusiasm can be built on Training issues can be addressed Appropriate deployment of staff can be made Staff satisfaction surveys will be essential

11. Goals of Evaluation Cook & Hussey (2002) identified four basic aims for the evaluation of a new service: Effectiveness in achieving the desired outcomes What are the aims from the end user perspective? What does the commissioner expect? The efficacy of the service elements Did the kit do exactly what it was supposed to do? Was the service safe and well delivered? The availability of the service to end users Is the service being offered to the right people? Are they getting it at the right time (i.e. when needed)? The efficiency (by cost) of service delivery What is the cost of delivering the service? What are the financial savings to the system? How much are end-users contributing to the cost?

12. Technical Measures Time to assessment Time to installation Time to answer Time to respond Percentage who can�t be supported with telecare No of return visits needed Faults recorded False alarms generated Failures to detect emergencies Subjective Analysis Assessment accuracy Appropriateness of telecare prescription Quality of installation Robustness of response protocols Satisfaction with outcomes Limitations of service NEED FOR EXTERNAL AUDIT AND REVIEW OF SAMPLE OF CASES Measuring Telecare Service Performance

13. Finding the Right Service Users Who is at risk of being admitted to residential care? Historic records Risk of admission index Who is at risk of hospitalisation? PARR algorithm Instincts of nurses and care staff

14. Top Reasons for Unplanned Medical Admission to Hospital Focus Group of Community Matrons COPD Chest pain/heart failure Polypharmacy (drug errors) Falls (and �off legs�) Panic with long term conditions Confusion Constipation Urinary retention Actual Reasons (based on HES data 2003-04) Mental health conditions COPD Heart disease Gastrointestinal complaints Renal disease Flu & pneumonia Falls (and �off legs�) Polypharmacy

16. Goals of Evaluation Cook & Hussey (2002) identified four basic aims for the evaluation of a new service: Effectiveness in achieving the desired outcomes What are the aims from the end user perspective? What does the commissioner expect? The efficacy of the service elements Did the kit do exactly what it was supposed to do? Was the service safe and well delivered? The availability of the service to end users Is the service being offered to the right people? Are they getting it at the right time (i.e. when needed)? The efficiency (by cost) of service delivery What is the cost of delivering the service? What are the financial savings to the system? How much are end-users contributing to the cost?

17. Cost of Delivering Telecare Equipment Purchase �475 (Cheshire) with 5 year life = �100 per annum Installation & withdrawal �135 and �65 respectively = �100 per annum for 2 year install Administration Assessment �100 - home visit with 2 hour survey = �50 per annum Monitoring �2 per week for basic service & telephone response = �100 per annum Response services Emergency call outs Up to �7 per week for 24/7 response = �350 per annum Less if linked with S.P. Floating Support services or if outsourced Batteries, maintenance, coordination & review �50 per annum with scheduled replacements TOTAL ANNUAL COST = �750 i.e. about �15 per week

18. Cost-Effectiveness of Service How much are the service users paying for the new telecare service? Is this more than, equal to, or less than the actual cost of service delivery? Do they think that they are getting good value-for-money? What are the likely savings made per service user per week as a result of using telecare? For the social care system? For the PCT? How might these savings and costs change over the next 5 to 10 years?

19. Telecare: delayed frailty progression

20. Defining Service Costs

21. Summary of Proposed Framework Baseline data for number of people currently receiving social services, and their rate of movement between bands of care Baseline data for number of inappropriate uses of ambulances and presentations to A&E Application of case finding tools Quality of Life assessment for service users Carer stress and health status review Staff telecare opinion survey Basic telecare system performance indicators Independent audit of a sample of assessments, prescriptions, installations and response protocols Cost of actual service delivery Projected savings through improved outcomes