Transcript Ten illustrations of best practice telecare service

Use of Resources Mini-Summit
Workshop “a” – Assistive Technology
© 2009 Tunstall Group Ltd
1
Agenda
• Presentation
– What is the opportunity?
• Questions
– What are the challenges that need to be
overcome to succeed?
– What support & core skills does the workforce
need to take this forward?
– What kind of support is required from the
regional infrastructure?
© 2009 Tunstall Healthcare Group Ltd
“Assistive Technology” in the context
of the Use of Resources
Telecare and Telehealth
© 2009 Tunstall Group Ltd
3
Evolution of Telecare
1st Generation - Responding to emergency situations
• Social Alarms - Giving 1.5m UK elderly and frail people the
confidence to live at home
Response Centre
User at home
calls for help
© 2009 Tunstall Healthcare Group Ltd
Response Network
Telecare solutions – Home Risks
GP
Escalation
Reassurance
Bed Sensor
Response
Centre
Managed
response
Housing
Services Social
Services
Voluntary
services
Smoke
Intruder
Inactivity
Fall
CO
Gas
Lifeline
Neighbours,
Carers...
© 2009 Tunstall Healthcare Group Ltd
Temp
Extremes
Flood
Lifestyle Monitoring – Preventative Telecare
monitoring using ADLife
Long Term Conditions where
‘vital signs monitoring’ offers limited help: Management
Case
Dementia
Specialist
Disease/
Specialist Disease/
Core
Management
Care
Management
Physically/Sensory Impaired
Arthritis
Self Care Support /
Self Care Support / Management
Management
Mental illness
Undiagnosed
Undiagnosed
Ageing
Pre-LTC
Healthy and Well
Security
Inactivity
Falls
© 2009 Tunstall Healthcare Group Ltd
Home-Based Monitoring
Environment
monitoring
Telehealth Service
• Early discharge monitoring
• Outreach service
• Real-time alarms after transmission
Temperature
ECG
Blood Pressure
Pulse Oxymetry
Breathing Rate
Body Weight
Monitoring Centre
Glucometry
Spirometry
© 2009 Tunstall Healthcare Group Ltd
Patient
at Home
Clinical
User
1 in 3 in the UK live with a Long Term Condition
People in the UK living with a chronic condition*
Conditions where remote biometric
monitoring devices can not help
MENTAL ILLNESS
10 million
DEMENTIA
1 in 5 aged 80+
LEARNING DISABILITIES
1.5 million
Conditions where remote
biometric monitoring solutions
can help
HEART FAILURE
0.5 million
ASTHMA
3.7 million and 1.5 million children
DIABETES
2.2 million diagnosed and 1 million
undiagnosed
ARTHRITIS
8.5 million
PHYSICAL DISABILITIES
10+ million
Source:
*Chronic disease management”, Dept of Health, May 2004
**HSE web-site
© 2009 Tunstall Healthcare Group Ltd
COPD
1+ million**
Current health
interventions can
control chronic
conditions not cure
Telehealthcare Delivery Model
Person Centred
Services
Alerts and
Reassurance
Managed Response
Emergency
Response
Social Care, Housing,
Community Nursing,
Friends, Family,
Therapy, Meals,
Voluntary Services…
Response Centre
Source: Tunstall
© 2009 Tunstall Healthcare Group Ltd
The Business Case
© 2009 Tunstall Group Ltd
10
Evidence leads to
mainstreaming service
BACKGROUND
• 52% rise in 75+ and 76% rise in 85+ by 2025
• Dependency ratio set to fall to 3:1 by 2025 from 4:1
• Significant shortfall in both financial and human resources needed to provide support
•
CSCI recommend greater use to be made of telecare
OUTCOMES
• In May 2006 TeleG (Gloucestershire telecare
project) was launched (using PTG)
•
Analysis of the two year project has revealed actual
net savings of
– £405,088 across 55 users
•
Extrapolating these average savings, the external
evaluator shows potential health and social care
net savings of
– £4.27 million across 368 users
– £11.6 million across 2000 users
•
Initial contributions to mainstream the service could be allocated pro rata 79% to
Community adult care and 21% to health sector
© 2009 Tunstall Healthcare Group Ltd
Meeting the needs of a growing ageing population
Telecare offered free to everyone 80+
Background
•
•
•
The demographic trend is acute in Essex (Tendring area has
highest level of over 65s per capita in Europe)
17,300 people have dementia rising to 27,800 by 2025
This demand will require spend budgets to rise by a factor
of three over next 10 yrs just to maintain services at current
level. This is obviously not sustainable
Outcomes
•
•
•
•
•
£87m worth of Public Pledges 2009-10 of which £4m is
dedicated to telecare equipment and support.
Essex strategy offers telecare free to everyone 80+
Currently 31,337 service users (Aug 09) across 9 District /
Borough Carelines
475 people issued equipment per month on average
Major marketing campaign to advertise the offer to potential
users and families
© 2009 Tunstall Healthcare Group Ltd
Costs and Benefits
•
•
•
Commissioning based comparison of support costs, 10% sample of
2,400 cases referred for assessment
– For all sample users
– £1 on Telecare is £3.58 saved in traditional care
– For all sample users with savings
– £1 on Telecare is £12.60 saved
Savings accrue to following years
08-09 total costs £317 per user for 5,662 users
No: of
Service
Users
No: with
Careline
Connection
Cost of
Equipment
Careline
Support
Savings
Saving
Ratio
Overall
Summary
240
143
£38,293.29
£14,928.00
£190,578.39
3.58
Children
-
-
-
-
-
-
Adults
18
5
£3,294.01
£532.00
£6,059.04
1.58
Older People
222
138
£34,999.28
£14,396.00
£184,519.35
3.74
© 2009 Tunstall Healthcare Group Ltd
North Yorkshire’s mainstreamed
telecare approach
Background
• By 2020 there will be 50% more people over 65,
54% more people with dementia
• If the general model of social care service provision remains
the same, by 2020 NYCC will need 3,420 more domiciliary
care packages and 1,817 additional places in care homes
at a cost increase of £43m per annum in real terms by
2020
Outcome
• Today, telecare is available for all individuals needing Adult
and Community Services support as part of the range of
mainstream personalised solutions to suit their individual
circumstances
• In the first year of the programme NYCC has
saved over £1 million
• Finance department has audited findings and approved
future budget reflecting these gains
© 2009 Tunstall Healthcare Group Ltd
Scrutiny Committee gives Telecare
mainstreaming the green light – 2007
In 2006/7 Care and Independence Overview and Scrutiny
Committee examined the Implementation of Telecare in North
Yorkshire. The report of the Chair of the Assistive Technology and
Telecare Working Group 01/02/07 concluded that:• When Telecare has been implemented by authorities in a “big
way” the evidence is the results can be quite startling, notably
in terms of releasing hard pressed resources.
• Telecare must not seen as an alternative to human contact, nor is it
seen as an opportunity to police people. It is about supporting and
managing risk, not about controlling behaviour.
• Members concluded, to gain the greatest efficiencies with resources
that preventative use prior to the service user becoming critical will
derive the maximum gains for organisations, users and carers.
© 2009 Tunstall Healthcare Group Ltd
Satisfaction survey
• A Directorate survey carried out in Spring 2008 which
had 96 respondents indicated the following outcomes.
– 86% - Telecare has helped me to carry on living at home
– 90% - Telecare equipment has given me more confidence/peace of
mind
– 95% - Telecare equipment has helped me to feel safer
– 92% - Rated Telecare excellent or very good overall
– 86% - Rated the assessment excellent or very good
– 92% - Were happy with the installation
– Of the respondents, 80% lived alone and 45% were owner occupiers.
© 2009 Tunstall Healthcare Group Ltd
Cost Benefit Analysis – 2008
38% saving in care packages
•
•
•
The last 138 people assessed for telecare during the period of Sept 2008
were analysed. Some people were new to ACS and some were pre-existing
with traditional support
7 cases were disregarded as outliers as it was felt they skewed the data too
favourably thus final total is 131 people analysed
Traditional packages were either the support that had previously been
received (if pre-existing case) or for support to new people was based on
care manager’s professional assessment of need if Telecare had not been
available.
Traditional package
Service type
Residential care
Community
Support
All packages
Count of
users
Actual package of care used including Telecare
Telecare
enhanced
% reduction Ave
Annualised Traditional annualised package
in traditional efficiency
cost £
Ave cost £ cost £
Ave cost £ Variance £ package £
£
60 784775.16
13079.59
417511.19
6958.52
355053.06
45%
5917.55
71 480024.46
131 1264799.6
6760.91
9654.96
356336.33
773847.52
5018.82
5907.23
123688.13
478741.19
26%
38%
1742.09
3654.51
© 2009 Tunstall Healthcare Group Ltd
Additional detail
• The comparison was made between what a traditional care package
would have looked like and what actual packages of care were
including a Telecare solution.
– In 64 out of 138 (46%), traditional package would have been residential, EMI
or nursing care
– In 74 out of 138, (54%), traditional package would have been care in the
home.
– Preliminary financial analysis is indicating
• a gross average efficiency per person on an annual basis of between £1,756
and £12,246 per area, averaging out at £3,654 countywide
• a 38% reduction in care package costs.
• The range is between a 90% reduction in package costs and in some cases
an increase if telecare added onto a residential package
© 2009 Tunstall Healthcare Group Ltd
North Yorkshire County Council
Success Factors
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•
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Strong leadership/vision
Clear 15 year commissioning plan
60+ case studies available
Over 5,000 professionals and partners trained
Embedded in performance management structure
– “Telecare enhanced care package” numbers performance
managed on a monthly basis
– Disciplinary offence not to mention Telecare in an assessment
process
• 12,265 telecare users (Aug 09)
“Here in North Yorkshire we have proven the case for telecare. It will
continue to be a critical part in our commissioning strategy and our
investment plans.”
Seamus Breen, Assistant Director – Commissioning and Partnerships
© 2009 Tunstall Healthcare Group Ltd
Blackpool PCT and “Vitalline”
• They have run telehealth for over a year
now, initially small scale 13 monitors
• The PCT and Social services wrote up their
findings and they have had a:
• 75% reduction in hospital admissions,
• 48% reduction in home visits by community matrons,
• 85% reduction in GP contacts.
• Mainstream progression
• Now 30 monitors
© 2009 Tunstall Healthcare Group Ltd
© 2009 Tunstall Healthcare Group Ltd
NHS Leeds – invest now to
save in the long-term
Background
•
•
•
Leeds PCT has 12,500 registered COPD patients just above the national
average.
8 telehealth monitors were rotated around 43 COPD patients
18 month trial funded by the Preventative Technology Grant
Outcome
• Benefits to the patient
– 98% of patients found the telehealth monitors simple to use & very
easy to understand
– The patients felt more empowered about their health
•
Benefits to the NHS
– During the trial, 67% of COPD patients did not access hospital
– Speciality respiratory nurse home visits were reduced by 20-25%
with peak periods of 50%
– With 8 telehealth monitors it was calculated that 172 home visits per
year would be saved.
– With 50 telehealth monitors this would increase to 1078 saved visits
•
Benefits to the Nurses
– More efficient visits to patients as nurses have triaged patients stats
to give quicker diagnosis
– More COPD patients can be treated with the reduction in nurse home
visits
© 2009 Tunstall Healthcare Group Ltd
Large Scale Telehealth Projects
• The trials go on, but some are not waiting
•
•
•
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Kent, Cornwall, Newham – (WSD participants)
North Yorkshire & York
Nottingham City
South Tyne & Wear
“…..industrial scale…..”
© 2009 Tunstall Healthcare Group Ltd
Agenda
• Presentation
– What is the opportunity?
– North Yorkshire – over £1 million of projected savings
• Questions
– What are the challenges that need to be overcome to
succeed?
– What support & core skills does the workforce need to
take this forward?
– What kind of support is required from the regional
infrastructure?
© 2009 Tunstall Healthcare Group Ltd
Telehealthcare Service Development
Plan Template
• 6 point plan
– Business case
– Leadership challenge
– Local services – “fit for purpose”?
– Winning over the front line
– Partner plan
– Self funder plan
© 2009 Tunstall Healthcare Group Ltd
We are ready to help
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– 07740 578000
• [email protected]
– 07725 041008
© 2009 Tunstall Healthcare Group Ltd