Telecare in Wales

1. Telecare in Wales Lee Davis Welsh Government 07808 727466 029 2080 1410 Lee.Davis@Wales.GSI.gov.uk www.ssiacymru.org.uk/telecare

2. Why is there so little Telehealth ?

3. Wales • Population under 3 million • 22 Local Authorities • 7 LHBs • All Co-Terminus with one or more local authority So : • Regionalisation • Pooled Budgets

4. Welsh ‘Call Centres’ In 2006 • 22 (23?) call centres mostly only 5,000 connections • Only one with over 10,000 connections • Every LA had one • Costs not known • Value not known • Potential not understood

5. Regionalisation • North Wales Regional Telecare Service • 6 local authorities and one LHB working through one call centre (admittedly on two sites) • South East Wales Improvement Collaborative (SEWIC) • 10 Local Authorities and 3 LHBs • Encompassing Gwent Frailty Project • Carmarthenshire & HywellDda RCT

6. Sustaining Social Services – A Framework for Action • Regionalisation • Cost • Integration of Telecare & Telehealth • Links with ICES

7. Cardiac arrest Cognition Nutrition Flood Fire Medication Gas Asthma attack Intruders Mobility Telecare to Manage Risk Environmental And Security Medical Social

8. A Robust Business Case !? A telecare enhanced care package is on average cheaper to social services than residential care only if the package is less than about 20 hours per week…

9. A Robust Business Case !? Random Sampling: Where institutional care is avoided social care costs were on average reduced by £216 per week Where telecare can mean a reduced care package at home the cost avoidance is on average £257 per week

10. A Robust Business Case !? In one county studied: Weekly cost of providing telecare service is under £9 per user per week – elsewhere probably £12-£15 Across Wales: On average 3.29 hospital bed days per year per client – a weekly saving of £14.12 per client

11. John Bolton’s Work for SSIA • List of 31 things that local authorities should do to save money • Telecareis Number 2 on that list • After Re-ablement ( – which it can support)

12. A Robust Business Case !? Conclusion The potential for a well targeted telecare service to reduce costs for social services is substantial

13. A Robust Business Case !? Conclusion Telecare is not a cost saving panacea Telecare was developed to manage the risks associated with independent living, to contribute to people’s health, mobility, social well-being and security, and ultimately to provide choice This should remain its primary goal

14. People Receiving Telecare at midnight on 31December 2009 17,946 Total Telecare Service Delivery = 19,699 Community Alarm users = 100,000 approx Home Care Service Users in any given week = 23-24,000

15. Would you describe your telecare service as mainstreamed? Yes = 20 (17)(15) No = 2 (5)(7)

16. Telehealth • We don’t Know how many – counting them now But Carmarthenshire RCT = 240 • Main supplier of Telehealth packages in Wales say that through the Telecare Capital Grant they sold .... 86 !!

17. Community Alarms Personal Contacts Existing Social Alarm Monitoring Emergency Services Monitoring Centre They used : POTS (plain old telephone system) systems

18. Passive/Reactive Telecare Passive Sensors in the home.. Personal Contacts Emergency Services Monitoring Centre It is still : POTS (plain old telephone system) systems

19. Duty Social Worker Mobile Warden Out-of-hours GP 24 Hour --Nurse Relatives & friends 24 hour Gas fitter Advanced Lifeline Unit Emergency plumber Smart Sensors Rapid Response Team Lifting service 24 hr. Home Care Fire service Police Contact & Coordination centre Community Alarm Centre Ambulance Alarms – A Reactive Telecare System Wireless alarm Response Team

20. Community Alarm Centre

21. NHS Direct Elderly living independently Healthcare Professionals Home Hub Appliance Social Worker Community Alarm Centre Telehealth Care Record • Home Automation • Security Wireless Network • Lights • Doors windows • Motion / Activity • Bed • Drawers • Kitchen • Bathroom Emergency Services Care Response Service, Warden etc Family, friends and volunteers Separate Health & Social Care Systems Cholesterol Monitor Blood-pressure Cuff Scales Glucose Sensor Pulse Oximeter MedicationTracking Coordination Required

22. Contact & Coordination Centres Potential Roles: • Hospital Discharge • Preventing Admission – co-ordinating services to support at home • Real Time updating and communication of care plan • Changing the care package – Responsive. Telehealth: • Installation, Maintenance, Administration • Traffic Light System means clinical involvement only at last point of process • This is Mainstreaming Technology !!!

23. Response Response Team 1 Response Response Team 2 Team 4 Response Team 3 Integration of Services Cost-effectively County 1 Home County 2 Coordination & Contact centre 8am–6pm Mon - Fri Coordination & Contact centre 8am–6pm Mon - Fri TELECARE MONITORING CENTRE 24/7 Coordination & Contact centre 8am–6pm Mon - Fri Coordination & Contact centre 8am–6pm Mon - Fri Clinic County 4 County 3

24. Telehealth on a Telecare Platform • We are ready • Seize the moment with the LHBs & Regional partnerships • The technology enables us to provide telehealth monitoring services and telecare alarm services alongside. • We need to be proactive and not miss this opportunity to provide truly integrated services

25. Cottage Industry Thinking • How far away are we from turning ‘Community Alarm Services’ in to ‘Contact & Co-ordination Centres‘ which can co-ordinate the delivery of integrated health and social care services • We are so far away that Care Line’ services are not being informed when service users are in care homes or hospital. Many have no idea where users are unless an alarm goes off • Does all the required service user information go in to the service? • Does all the call centre’s knowledge of service users’ needs & history inform how you can maintain people’s independence. • Are the ‘Call Centres’ really full players in the delivery of health & social services • Are they really part of the mainstream? • Or are they are still a ‘one-trick-pony’ re-active service?

26. What We Know & What We Need Communication Hubs 3 Functions 3 Contexts Library Function National Call Handling Regional Care Coordination Local

27. Framework of Services for Older People – 2011 • The focus of this ‘Framework of Services for Older People’ will be upon how these public services work together to promote the independence of frail older people either in their own homes or in other homely settings. It will contribute to the achievement of modern, accessible and responsive services capable of meeting people’s needs and of being delivered flexibly, consistently and sustainably across organisational boundaries. In addition to enabling people to live as independently as possible, services must assist them to recover independence where this has been threatened, must promote and protect their dignity, must promote social inclusion, must support them at times of difficulty and protect them from harm.

28. Framework of Services for Older People – 2011 The word ‘Telecare’ appears 51 times

29. Framework for Telecare • Within the next few months the Welsh Government will be publishing updated guidance that will build upon lessons learned over the past five years and will continue to promote the strategic development of this service. The guidance will be directed towards ensuring that we make the best use of telecare and realise the benefits of closer integration with other services such as telehealth, community equipment, adaptations, etc. We also need to exploit the potential of the communications centre at the heart of telecare to provide more effective services.

30. The Social Care Battleground Question: What will prevail? -Short term survivalism or long term sustainability. Answer: Organisations will need to work together in partnership and with innovation if we are going to meet the challenge to demonstrate that preventative services are more efficient in the long run

31. What We Know & What We Need The Sustainability & Mainstreaming of Telecare depends upon the development of a national comprehensive care strategy that embeds telecare into health, housing and social care services

32. What We Know & What We Need Pooled Health & Local Authority Budgets to • Purchase telecare and telehealth equipment • Integrated data collection & management • Co-supervision of telecare and telehealth

33. What We Know & What We Need National/Regional purchasing strategies with clear specifications to secure better products from suppliers A full-time professional in charge of Telecare / Telehealth regionally. With a level of authority and skills

34. What We Know & What We Need Better and more consistent training for users, referrers and assessors Fully dedicated assessors Charging policies that remove perverse incentives – public/private funding strategy ? A Robust Business Case

35. Why is Telehealth Delivery so low ? • This presentation has concentrated on the supply side • And the received wisdom is that we need get clinical involvement (esp. GPs) to work through telehealth • Why aren’t clinicians flocking to it? • Is it because health care is still too Hospital based> • But is there a nightmare scenario that service user (patient) demand is low ?? – have we measured it? • Is it that telecare is still too ‘cottage industry’ to help? • Is it that Health & Social care are still not able to work together? • Or is it just the stage we are at?

36. Telecare in Wales Lee Davis Welsh Government 07808 727466 029 2080 1410 Lee.Davis@Wales.GSI.gov.uk www.ssiacymru.org.uk/telecare