Transcript Document

TKN -THE WAY FORWARD
A CLINICIANS PERSPECTIVE
Dr Beverly Castleton
Consultant Physician, Surrey PCT
9th February 2007
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Introduction
Model of Care – CDM – “Out of Hospital”
Pilot to Practice – Mainstream Telecare
WSD – Other DOH initiatives
SAP – CAF – eSAP/CAF
Technological developments
Evaluation and Commissioning
Conclusion
MODEL OF DELIVERY FOR
CHRONIC DISEASE
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Out of Hospital
Single Assessment Process Delivery
Common Assessment Framework
Risk Management
Reshaping Patient-Centred Care
White Paper – Our health, our care, our say
A New Ambition for Old Age
RISK STRATIFICATION
Case
Management
Highly complex patients
Disease
Management
High risk patients
Supported self-management
70-80% of people with chronic conditions
Population-wide prevention
Managed
care in the
community
and hospital
settings
covers all
levels of the
triangle
TELECARE DEFINITION
Telecare is the delivery of health and social
care services to people usually in their own
homes using a combination of sensor and
information and communication
technologies (ICT).
COLUMBA
LESSONS LEARNT
1997 - 2006
TELECARE
Prevention
Information &
Communication,
e.g. health advice,
triage, access to
self-help groups
Improving
functionality
Safety & security monitoring,
e.g. bath overflowing, gas left
on, door unlocked
The individual in their home
or wider environment
Electronic assistive technology, e.g.
Environmental controls, doors
opening/closing, control of beds
Mitigating
risk
Personal
Monitoring:
Physiological signs
Activities of daily
living
Prevention
THE EMERGING INFRASTRUCTURE
• Assessment &
referral
The individual
in their home
NCRS
Alarm !
• Equipment
• Monitoring
• Response
• Review
Record event
Response
protocol
Response: home visit,
Check status emergency services,
remote change
Check
Call centre
Response
provider:
neighbour, relative,
ambulance, HCA, fire, police
LOGISTIC & INFORMATION PATHWAY OF A TELECARE
SERVICE
Entry
(Re) Assessment of Need
(SAP)
Review
Care Package
Development
Telecare
Prescription
and a
Response
Protocol
Community
Response
Home survey
Call
Handling
Monitoring
Equipment Provision
Installation and
Maintenance
PARTNERS IN PROVISION
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Intermediate Care/Older Peoples’ Services
Dementia Care
Falls Services
Primary Care – GP/DN/Out of Hours
Community Alarm Service
Ambulance Service
ANPs (Advanced Nurse Practitioners)
Community Matrons
SWOPs (Specialist Workers for Older People)
Specialist Nurses in Chronic Disease Management
Patients, Carers and Relatives
Home Care?
PARTNERS IN PROVISION
• Flexible Systems
• Quality
• Not necessarily hours
TELECARE IS AN ADJUNCT
TO THE SYSTEM NOT A
SUBSTITUTE FOR CARE AND
HANDS-ON DELIVERY
3 MIGRATION PATHWAYS
REDESIGN
IT
Asst
Skills
Integration
Clinical Networks
Whole System Delivery
Interagency
Work
TRUSTED ASSESSOR
TRAINING
CONTEXT
• At least 12 major government reports since 1998 have called
for telecare
• Delivering 21st century IT support for the NHS: ‘home
telemonitoring’ to be available in 100% of homes requiring it
by Dec 2010
• £80m in Comprehensive Spending Review for developing
telecare and social alarm services
• The elements of a telecare framework are in place – NCRS,
social alarm service, ICES
• Numerous trials shed light on implementation problems and
individual outcomes
TECHNOLOGY IMPACT
• Reduces patient journeys, hospital visits and
hospital admissions
• Saves the time of healthcare professionals
• Supports individuals living at home to look
after themselves
• Improves the quality or effectiveness of the
care or treatment that is delivered
• Helps to manage the risk
TELECARE – The Challenge
• Limited mainstream telecare in England as yet, no
joint commissioning – telecare not provided as a
‘care option’, what happens with practice-based
commissioning?
• 150 SSDs, 152 PCTs, 238 DCs, housing assns,
alarm providers would need to be involved in
assessment and care planning via SAP/FACS etc
with information sharing
• Who is the client?
• Who pays?
TELECARE – The Challenge
Mainstreaming
• Creating the organisational structure for
implementation
• Retraining staff
• Apportioning costs
• Deciding eligibility
• NEEDS IT BACK UP TO IMPROVE
INFORMATION FLOW
PTG
• Walton Community Hospital Project –
Physically & mentally frail patients
Ward multi-disciplinary Teams
Telecare Assessor – Team Member
• Multi-disciplinary Assessment Panels (MAPS)
Community based
Very complex frail elderly
SINGLE ASSESSMENT
PROCESS
• Common Assessment Framework
Who Leads?
What Criteria?
All Levels of Need
“There is the tantalising possibility for public
policy to meet more people’s desire to remain
independent for longer, while at the same time
saving money overall”
Source: “Assistive Technology – Independence and Wellbeing 4” Audit Commission, Feb. 2004
CORE PROCESSES FOR CHRONIC
DISEASE MANAGEMENT
• Involve the patient and customise for their needs
• Easy access
• Manage populations through integrated databases –
screen and risk manage
• Develop robust networks between:
- patients (support groups)
- patients and professionals (communities of care)
- professionals (communities of practice)
CORE PROCESSES FOR CHRONIC
DISEASE MANAGEMENT
• Training and development for patients and
professionals
• Develop expert systems:
- expert patients
- expert professionals
- expert ICT with protocols, guidelines etc that
develops shared knowledge
• Clinical governance that depends on good evaluation
and the ability to track the patient in the system
MAJOR SWOP/STOP NETWORKS
A&E
Wards
MAU
Specialist
based
assessment
SWOP
System
Community
Information, skills flow
Rehabilitation
Social Services
PARKINSONS DISEASE MANAGEMENT
Primary
Care
Team
PD
Society
Day
Resource
Unit
Neurologist
Pt with
PD
EPICS/Comm.
Matron
PDLN
Arrows indicate flows
of information, skills
and care
Geriatrician
Home Care?
THE PARKINSON’S DISEASE SUPPORT
NETWORK
New Electronic Support Network for People with
Parkinson’s Disease
• A collection of linked websites, or “virtual
communities” to help patients, their families
and healthcare professionals to support
sufferers of Parkinson’s Disease
• Medixine/North Surrey PCT/Imperial
College, London
KEY ISSUES
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Who is offered Telecare?
What levels of sophistication of equipment?
Do we need national criteria?
Should the equipment be free?
Should the revenue cost be means tested?
Should it be disease led?
DEPARTMENT OF HEALTH
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Long-term conditions
CAF & Care Planning
e SAP/ e CAF
NSF’s
A Recipe for Care – Not a Single Ingredient
WANLESS Social Care Review
Impact of Telecare on the need for Domiciliary
Care,*2005/6 to 2014/5
Hours of care (thousands)
860
840
820
800
780
No Telecare
Telecare
760
740
720
700
680
2005/6
2007/8
2009/10 2011/12 2013/14
*Potential impact of the 2006-08 Preventative Technology Grant investment
on the estimated number of hours of domiciliary care needed in Telecare
Valley (excluding care homes).
• The provision of telecare has an immediate impact
on total staffing levels. When assessing staffing, it
is not only formal carers who need to be included,
but also the call centre staff and response teams on
which telecare networks crucially depend. The
demand for staff is particularly high at the
beginning of a telecare investment project when
this human infrastructure needs to be set up, the
telecare equipment installed and everyone trained
to use it.
TECHNOLOGY MOVES ON
Digital TV
Flexible Platforms for Chronic Disease
management delivery
Frailty Registers
Compliance improvement
CONCLUSIONS
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Major Service Redesign
Whole System Integrated Approach
Use the IT Agenda as a catalyst for change
Single Assessment Process to mainstream Telecare
Cross Organisational Workflow and Workforce
required
Managing the Risk is essential
Patient and Carers need to be part of the team
Accuracy of Data essential
Win Win
CONCLUSIONS
TELECARE CAN
 Postpone and divert people from RH/NH
 Reduce the need for hospitalisation
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 Need robust data for reapportioning costs
 Lets resist short-termism getting in the way
 Telecare is a useful adjunct to care
 Needs to be part of a care prescription to reduce
routine tasks and improve quality and flexibility of
Care Delivery at Home
Research &
Evaluation & Commissioning
PAYOR
DATA
PROVIDER
PATIENT (&
CARER)
REFERENCES
• Audit Commission, Assistive Technology:
Independence and Well-being 4, February 2004
• Audit Commission, Older people – implementing
telecare, July 2004
• Department of Health, Building Telecare in
England, July 2005
• Department of Health Health and Social Care
Change Agent Team (CAT), Housing LIN
Factsheet no 5 – Assistive Technology in Extra
Care Housing, August 2004
REFERENCES
• Department of Health ICES (Integrating
Community Equipment Services, Telecare
Implementation Guide and numerous fact sheets,
July 2005 onwards
• Health Select Committee, The Use of New
Medical Technologies within the NHS, Fifth
Report of Session 2004-05, April 2005
• Department of Health Application of Telecare and
Long Term Care
• Telecare Alliance, Website address:
www.telecarealliance.co.uk
• Wanless Social Care Review, King’s Fund, 2006