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TECHNOLOGY ENABLED CARE

Supporting Service Transformation

Delivery Plan 2018/19

April 2018

Introduction

1. The TEC Board agreed four Strategic Priorities in August 2017 for furthering the

development and adoption at scale of Technology Enabled Care over the next

three years. These built on the evidence and implementation to date and are

informed by wider policy developments and emerging priorities. These four

priorities are

Preparing for the future – identifying and testing new approaches that offer the

potential to achieve change at scale

Developing approaches once for Scotland – developing approaches that have

been shown to be effective, supporting scaling up across Scotland and

addressing barriers that require national level action

Building capabilities and supporting improvement – championing,

supporting, gathering and promoting the evidence of what works, to develop the

culture and skills that recognise and use digital TEC including through developing

business cases, supporting strategic planning and delivery.

Transforming local systems – supporting exemplars that are seeking to

transform local health and social care systems using digital technology to shift

local systems upstream to prevention and self-management

2. This Delivery Plan sets out the ‘deliverables’ for each of these four strategic

priorities. High level deliverables (which will evolve further on the basis of health

and social care delivery /service transformation requirements) are set out for the

period to 2021, with specific deliverables for 2018/19. Key work streams in

2018/19 that will enable the Programme to deliver are described, with the

associated committed and planned budget allocation.

3. The TEC Programme will form a key component of the Digital Health & Care

Strategy, published in April 2018. Currently the four TEC strategic priorities align

well with, and support, the Digital Health & Care Strategy. There may however be

a requirement to adjust the TEC priorities and this Delivery Plan as that

overarching Strategy and associated implementation plan develops. Some of the

activities outlined here may be taken forward as part of the broader approach to

digital health and care, but the exact mechanism for that has still to be determined.

The Digital Health & Care Strategy

4. Person-centred health and social care is at the heart of our strategic agenda in

Scotland, but rising demand from services is placing systems under increasing

pressure. Digital technology offers the potential to meet this rising demand for

public services and growing expectations amongst people using services. Making

better use of data and technology has the potential to improve the quality and

reduce the cost of services, as well as giving people more control over their own

health and wellbeing.

5. The Digital Health & Care Strategy1 focuses on how digital can support the

strategic aim for Health and Care in Scotland in delivering high quality services,

with a focus on prevention, early intervention, supported self-management, day

surgery as the norm, and – when hospital stays are required – for people to be

discharged as swiftly as it is safe to do so. The vision is as a citizen of Scotland:

‘I have access to the digital information, tools and services I need to help

maintain and improve my health and wellbeing. I expect my health and social care information to be captured electronically,

integrated and shared securely to assist service staff and carers that need to see it…

…and that digital technology and data will be used appropriately and innovatively

to help plan and improve health and care services

enable research and economic development

and ultimately improve outcomes for everyone.’

6. The Strategy builds on achievements to date and sets out future development and

priorities. Its focus is two-fold

“(i).We wish to empower citizens to better manage their health & wellbeing,

support independent living and gain access to services through digital means. We know this is leading to a shift in the balance of care by using the tools and technologies that we are already increasingly using for all other aspects of our

lives. In order to achieve this at scale;

(ii) We need to put in place the underpinning architectural and information

governance building blocks for the effective flow of data across the whole care system that will enable the transformational ambitions of the Health & Social Care Delivery Plan, including public health and social care reform

priorities.”

7. Six key ‘Domains’ are set out in the Strategy.

Domain A: National Direction

Domain B: Information Governance, Assurance and Cyber Security

Domain C: Service Transformation

Domain D: Workforce Capability

Domain E: National Digital Platform

Domain F: Transition Process

1 Scotland’s Digital Health and Care Strategy: Enabling, Connecting and Empowering. April 2018

Technology Enabled Care, including the TEC Programme and approach to date, has

an important contribution to make to all these Domains but in particular to Domain C

– Service Transformation. This has a focus on spread and adoption at scale, service

redesign and service change.

Technology enabled care

8. Technology enabled care is a cornerstone for connecting and empowering citizens,

and key to ambitions for transforming the delivery of care. It makes a critical

contribution to better health and wellbeing in the community by adopting tools and

approaches to enable people to improve and manage their own health, remain

independent and safe, and by improving access to, and the efficiency and

effectiveness of, information,

advice, care and treatment

provided. This is widely

recognised.

9. The key role for technology

enabled care is reflected in a

growing number of national

strategies that recognise the

contribution to be made by

digital solutions and include

specific actions that include

technology enabled care.

10. The contribution of technology enabled care was considered by an external,

independent panel of UK and international experts asked to advise the Scottish

Government on how digital technology can support Scotland’s aim for high quality

health and social care services with a focus on prevention, early intervention and

supported self-management. Their report2 identified a number of successes that

have been achieved in specific areas, including using technology enabled care in

prevention and early intervention. The report cites “Scotland is already an

international leader in technology enabled care …”. The Panel concluded that…

“While the TEC Programme has demonstrated the contribution of technology to

improvements in health and care services, there is now a need to integrate these

opportunities in a more effective and sustained way. In order to do this, digital

technology now needs to transform the way in which health, housing and social

care services are provided, empowering people to self-manage and live more

independently thereby reducing demand on services (including pressures on the

2 Digital Health and Care in Scotland: Report of the External Expert Panel April 2017

Technology enabled care in Scottish Government Strategies: Examples

The Health and Social Care Delivery Plan

Social Care Reform agenda

Primary Care Innovation Fund

Joint Housing Delivery Plan

AILIP Scotland’s National Dementia Strategy

Mental Health Strategy

The Modern Outpatient

2030 Nursing Vision

Achieving Excellence in Pharmaceutical Care: A

Strategy for Scotland

workforce) and improving outcomes and quality of life. In particular, evidence-

based and scalable approaches are needed to be adopted at a national level, so

that local health and care systems can focus on using digital technology for

upstream prevention, self-management and greater independent living.”

External Expert Panel Report

11. The Health and Sport Committee’s report ‘Technology and innovation in health and

social care’3 applauded initiatives such as developments in telehealth/telecare,

video-conferencing and virtual clinics. The report did, however, note that the

spread of such approaches should be accelerated, which chimes with the External

Panel’s recommendation that “evidence-based technology enabled care…be more

broadly implemented at scale across Scotland”. It noted that many submissions

were supportive of the TEC Programme with some specific examples cited. It also

set out a number of recommendations including the opportunity for person-centred

approaches, the need for a national ‘Once for Scotland’ approach, a requirement to

support scale up and adoption of evidence-based technologies and to address

cultural barriers to encourage widespread acceptance and uptake of technology

and innovation. The TEC Programme is already making a contribution to these

aims and this current Delivery Plan develops this further.

12. We are now at the point where the challenge is no longer about proving the value

and potential of technology enabled care: rather it is achieving widespread

adoption so that technology enabled care is integral to ‘business as usual’ and

redesigned services and care pathways.

The TEC Programme

13. The national and centrally managed programme enables learning to be gathered

from local, UK and international experience at the same time as cross Scotland

issues are being addressed on a Once for Scotland basis. This includes

Testing new approaches and identifying new opportunities for scale up

Supporting scale up and accelerated adoption of technology enabled care

Supporting local improvement and change

Identifying common issues and barriers to change, and finding solutions

Gathering and sharing learning, such as the development of common

service models, gathering evidence of impact and effectiveness, and the

development of toolkits

Facilitating knowledge exchange and collaborations with European and

international regions and countries.

14. The importance of this national programme in coordinating and driving change, as

well as the challenges it faces, has been emphasised in a recent study of the TEC

3 Health and Sports Committee Technology and innovation in health and care. 1st February 2018

Programme.4 A key finding from this evaluation is that, even where technologies

have established an evidence base, the pace of implementation can be slow – a

common feature in other programmes and evaluations. In relation to technology

enabled care, implementation is challenging because of the rapidly evolving nature

of the technologies, the importance of context and the need for multi-stakeholder

buy-in. Workshops undertaken with stakeholders as part of the study found strong

support for the contribution of the TEC Programme to supporting implementation.

The study also concluded that the Programme is already employing many

implementation strategies that are consistent with international best practice.

15. The Programme has a wide scope that has developed as new opportunities and

barriers have been identified. Whilst the Programme’s primary focus has been on

service improvement and transformation, it has also funded certain ‘product’ and

‘infrastructure’ developments. The TEC Programme continues to provide funding

for the health and social care portal proof of concept work, and led the earlier work

on a Digital Platform. The TEC Division within the Scottish Government also

provides some funding to the Digital Health & Care Institute (DHI) to support

innovation to address specific key challenges for health and social care, ensuring a

supply of ‘next generation’ TEC options.

16. The TEC Programme has benefited to date from very effective cross sector

leadership at Board level and collaboration with other national organisations, in

particular NHS 24 and SCTT, NHS NSS, NHS NES, DHI, Local Government Digital

Office, and national organisations including Scottish Fire and Rescue, Alzheimer

Scotland, Scottish Federation of Housing Associations, to support development

and implementation activities with joint programmes of work. Local health and

social care partnerships and other national and local organisations (e.g. third

sector, independent care and housing) have also continued to contribute to

development work and support implementation and improvements. This work will

inform the implementation plan for the Digital Health and Care Strategy and

contribute to the new delivery arrangements required going forward.

Evolving our approach

17. The four Strategic Priorities for technology enabled care will see investment in

approaches that have been shown to be effective focusing on a smaller number of

programmes /initiatives, a number of which have been referred to in the recent

External Panel and Health and Sports Committee Reports. There are important

shifts in emphasis and focus.

Investing higher levels of funding to achieve integrated, ‘whole’ system digital

health and social care that builds on the full range of technology enabled care,

such as Home & Mobile Health Monitoring, video-conferencing, telecare, and

online tools linked into core eHealth systems

4 Just Economics TEC Programme Data Synthesis and Evaluations Options Study. March 2018

Investing only in digital technologies

Investing in evidenced based approaches to support scale up and adoption

across Scotland, building on success to date

Using technology enabled care as a driver of transformational change in local

systems, shifting away from ‘digitisation’ of current services .

Facilitating the transition of successful programmes and approaches to delivery

partners shifting to business as usual

Seeking out and supporting innovation and inward investment opportunities.

Ensuring closer alignment and collaboration with other national change and

improvement programmes

Giving greater focus to the need for culture change and skills development within

the health and social care workforce, and on supporting change management

and addressing barriers to change

Promotion and dissemination of outcomes, outputs and lessons learned to

national and international stakeholders

Adopting evidenced based implementation framework to bridge gap between

‘science’ and practice’ and support mainstreaming of technologies

Outcomes and Deliverables

18. For each of the four Strategic Priorities, we have identified (a) The outcome that we are aiming to achieve over the next three years

(b) ‘High level’ deliverables, relating to each outcome

(c) Specific deliverables for 2018/19

(d) Committed and planned budget allocation for the constituent work

streams.(See Annex A)

19. The following sections set out the outcomes, high level deliverables and the specific

deliverables for 2018/19. The associated budget allocation is also provided.

Strategic Priority 1: Preparing for the Future

Supporting Domains C, D and E: Digital Health and Care Strategy

Identifying and testing new approaches that offer the potential to achieve change at

scale

Outcome and ‘high level’ deliverables

20. The purpose is to continue to identify approaches using technology enabled care

that have the potential to offer significant change and improvement at scale. The

focus will be on identifying approaches to support service change, rather than on

the new technology itself (where the lead lies elsewhere e.g. the Digital Health &

Care Institute, CivTech®, Censis etc.). This might be about testing “new to you”

technology, applying technology in a different way or at a different time in a

pathway, or testing out a model that other partnerships have found successful.

21. There are also opportunities to test the potential of next generation technologies.

Collaboration with the Digital Health & Care Institute (DHI) and other Innovation

bodies is crucial to ensuring that pipeline tools and approaches are connected to

our requirement for implementation and scale up. This also provides opportunities

to lever inward investment through UK, EU and international funding opportunities

and business developments building on success to date.

22. Our work will continue to support small tests of change, but will extend to

developing models of service delivery and approaches that support ambitions in

the Digital Health & Care Strategy to accelerate the pace of change and shift

systems towards prevention and supported self-management. An important shift in

approach from 2018 is to make clearer the strategy that will guide investment and

identify a flow of ‘scale up’ opportunities that are relevant, useful and effective.

23. Using TEC Programme funding to leverage additional international and other

investment has been very effective and has helped generate new thinking to shape

approaches. This will remain a key part of our approach in our forward

programme. The TEC International Engagement Team and associated

International Engagement Action Plan5 will continue to facilitate opportunities for

collaboration, position Scotland’s interest in shaping funding calls and facilitate

networking and knowledge exchange between international partners. This will be

particularly important going forward after the UK exits the European Union in March

2019.

24. The outcome to focus this strategic priority from 2018-2021 is

Preparing for the Future

Partners have access to a pipeline of service improvements and innovations in

technology enabled care that are effective, can be adopted at scale and support

the delivery of key national priorities, while maintaining Scotland as an

international leader.

25. Associated ‘high level’ deliverables (2018 – 2021) for this outcome are

A clear pipeline of innovative solutions, products and approaches and an

associated implementation model are in place for translation into mainstream at

scale services and pathways across health and social care

Further health and social care challenge competitions and feasibility studies

where digital innovation can deliver improvements that are effective and can be

adopted at scale have been undertaken

5 International Engagement Action Plan Technology Enabled Care and Digital Healthcare Innovation 2017 – 2019

The market has been sufficiently stimulated into providing suitable ‘next

generation’ technologies, particularly for the shift to digital telecare and in the

integration of telecare and telehealth

Further UK and international funding collaborations have been established,

bringing inward investment in support of further improvements and innovations in

technology enabled care.

Specific deliverables 2018/19

26. Much of the initial groundwork required within this strategic priority will be taken

forward as part of the broader approach to supporting innovation within the Digital

Health & Care Strategy. An immediate priority will be to review our approach to

identifying, testing and then growing opportunities around digital health, including

technology enabled care and emerging tech such as the Internet of Things (IoT).

This review will identify key gaps in services and approaches, where technology

enabled care offers potential solutions alongside wider service redesign. The

review will gather stakeholder views – national and local – from across sectors and

interests to inform its conclusions. We plan to complete this review by October

2018. The review will then shape the development of future investment under this

strategic priority.

27. Within the TEC Programme, we will build on the successful use of tests of change

and have a further phase of tests of change and or scale up feasibility studies

during 18/19. These will offer opportunities for local partners to access small scale

funding that will support local change programmes. Calls for submissions will also

target specific topics or issues, which have already been identified as key areas of

opportunity and change where technology enabled care has an important role to

play.

28. The TEC Programme focuses on service change and improvement rather than

developing the new technology itself. The Programme has however provided

funding for the Digital Health & Care Institute (DHI) to support the development of

new products in technology enabled care. Further funding for DHI is included in

the 2018/19 budget, and an early task will be to agree a clear specification and

programme with DHI that supports the wider Digital Health & Care Strategy.

29. The TEC programme with the Scottish Centre for Telehealth and Telecare (SCTT)

has been very successful to date in securing inward investment from international

and other sources. This has offered Scotland access to international expertise and

opinion, as well as enabling us to develop important new approaches, such as

Living it Up. The Programme will continue to monitor inward investment

opportunities as part of the division wide activity in this area. It is expected that at

least two major proposals for inward investment will be completed in the year.

30. Deliverables are set out for 2018/19 below relating to specific activity under the

TEC Programme and wider activities of Scottish Government’s wider technology

enabled care activities.

Deliverables in 2018/19 (budget circa £2,250,0006)

A structured programme of tests of change and feasibility studies has been

undertaken that supports the increased use of technology enabled care in both

local and national change programmes

o 12 tests of change or feasibility studies undertaken by March 2019

o Review and analysis of tests of change and scale up opportunities to date to

identify themes, opportunities & barriers by June 2018

o Further tests of change underway by September 2018.

Horizon scanning undertaken of new UK, EU and international funding

opportunities that support scale up, by July 2018, with an ongoing horizon

scanning process in place.

An enquiry to assess the potential application of TEC focusing on children and

young people is undertaken by June 2018 with a plan for developing a

programme agreed by September 2018.

A review has been completed in collaboration with DHI that identifies gaps in

approaches, services (and products) and informs priorities for future investment

priorities

o Initial review completed by October 2018

o Recognised innovation pipeline and process of continuous review in place

by March 2019.

Market stimulation of appropriate next generation solutions (including the

integration of state systems with consumer market / citizen self-monitoring &

self-management solutions) to better leverage and expand scaled-up services

using an enhanced national infrastructure commenced by September 2018.

The business case for the next five years of the DHI has been agreed in

collaboration with the Scottish Funding Council and the Enterprise Agencies by

March 2019.

At least 2 major proposals for inward investment from UK, EU and international

funding programmes have been submitted by March 2019.

6 Part of this funding is contributing to supporting digital health and care innovation opportunities and will be

reviewed with regard to progress with levering inward investment

Strategic Priority 2: Developing approaches Once for Scotland

Supporting Domain C, D, E and F: Digital Health and Care Strategy

Developing approaches that have been shown to be effective, supporting scaling up

across Scotland and addressing barriers that require national level action


31. A key requirement, identified across national strategies and highlighted in the

External Expert Panel draft report and Health and Sports Committee Inquiry

referred to above, is identifying approaches that can be scaled up on a Once for

Scotland basis. Building on the original Telecare Development Programme scale

up, there has been important progress facilitated by TEC funding to support

national coverage and transition to business as usual for ALISS and Living it Up

(LiU), national scale up of cCBT (computerised cognitive behavioural therapy) and

scale up of self-management of hypertension in three NHS Board and associated

Health & Social Care Partnerships to date. However, the significant priority in the

forward programme is to accelerate this process – and this will be the core focus of

the Programme with the highest level of funding. We want to build on and learn

from these successes and extend them, focusing initially on national scale up of

hypertension and diabetes technology enabled care solutions (as recommended by

the Expert Panel), whilst continuing to identify other opportunities through the

Preparing for the Future work streams.

32. A main focus of the Once for Scotland approach is that digital technology will

support Scotland’s commitment for high quality health and social care services that

have a focus on prevention, early intervention and supported self-management.

33. Integration of health and social care requires parallel action in achieving integration

between telehealth (HMHM) and telecare technologies, and integration into core IT

systems. The ambition within the overall Digital Health & Care Strategy to create a

single national platform emphasises the importance of joined-up care.

34. Building on earlier work around remote consultations, the opportunity to support

service transformation and pathway redesign across health and social care will be

facilitated by a national approach and model (e.g. Attend Anywhere) with a

particular focus initially on scheduled care.

35. Preparing for technology changes, such as the analogue to digital telephony

switch, to ensure that technology enabled services are fit for purpose has been a

key focus of the TEC programme. This switch to digital technology is essential

work required over a number of years. The Programme’s support will minimise any

risk for vulnerable people in the transition, but will also seek to maximise

opportunities for integration of health and care technologies and data to support

improved outcomes for people.

36. An important role for the TEC Programme has been to identify barriers to adoption

and scale up of technology enabled care, and to find solutions through

standardisation and common approaches, so that the focus can be on applying

approaches to local contexts and avoiding ‘reinventing the wheel’. We anticipate

that there will also be a continuing role in national procurement to support some of

this scale up, most obviously of licences.


Once for Scotland

Improved Outcomes for citizens, service improvements and economies of scale

have been achieved by developing common approaches and standardisation,

national pathways and efficient commissioning and procurement arrangements.

38. Associated ‘high level’ deliverables (2018 – 2021) for this outcome are

cCBT and digitally enabled hypertension services have moved into sustainable

business as usual

Technology enabled pathways for diabetes and at least one other long term

condition are being embedded

Citizens can routinely access appointments remotely, and TEC has contributed

to a significant reduction in outpatient appointments

An integrated service delivery model for remote monitoring and response for

health and care needs has been developed

Digital telecare has been proven and a national replacement programme for

analogue telecare is well underway

A recognised ‘at scale’ implementation model is in place, and barriers to local

service transformation and scale up that require action at national level have

been identified and addressed on a continuing basis.


39. In order to work towards these aims, our initial focus for developing technology

enabled pathways in 2018/19 will be on those specific areas where the evidence is

strongest, such as in the treatment of mild to moderate depression (cCBT), the

diagnosis and management of hypertension, and the management of diabetes.

(a) cCBT has already achieved national coverage. During 2018/19 the primary

focus will be on achieving a sustainable business and funding model. We will

also evaluate the approach to date to identify what has worked, and why, so

that learning can inform further expansion as well as approaches in relation to

hypertension and diabetes.

(b) Progress in those areas that have adopted remote monitoring for

hypertension has been very good, with very positive feedback. There will be

major drive in 2018/19 to secure adoption in other areas, with an expectation

that a further 10,000 people will be using remote monitoring for hypertension

by March 2019.

(c) During 2018/19, we will expand the use of MyDiabetesMyWay to support self-

management and wellbeing, and undertake a communications and marketing

campaign to support use of a new MyDiabetesMyWay app.

40. Expansion of the Attend Anywhere platform to provide video consulting capability

across Scotland will be taken forward. This will include supporting the re-design

and local implementation of modern outpatient services through use of video

consulting, with an expectation that 25 new service start-ups will be achieved by

March 2019.

41. In addition, work will continue on preparing the way for a national switchover to

digital telecare, exploiting the opportunities this brings. There is a substantial

programme in place to coordinate and drive forward preparations for switch over

from analogue to digital telephony services (A2D). Its focus in 2018/19 will be on

understanding the current and planned connectivity landscape, and supporting the

switchover of initial waves of telecare users. We expect that by March 2019, six

partnerships will be live with 1,000 digital telecare users and a further 1,000 digital

telecare users will be in ‘clustered models’.

42. We will take forward our work with the housing sector, with a particular focus on

using the sector’s ‘reach’ with people who are not in receipt of formal care services

but may be in the future. The initial programme has increased awareness of the

potential of technology enabled care and there are some housing providers

showcasing the potential contribution that housing can make. There is however

more work to be done, including ensuring that housing providers with sheltered

housing and community alarms systems are aware of the implications and the

opportunities around the switch from analogue to digital telephony.

43. During 2018/19, we will establish a regular review process for making sure that

barriers that require national action are identified and assessed. We expect that

this will involve both horizon scanning to identify emerging issues (such as for

example the growth in the internet of things and related issues around cyber

security) and a process for identifying common barriers to implementation and

delivery at local level.

Deliverables in 2018/19 (budget circa £3,775,000)

Supported self-management

An additional 10,000 people are using remote monitoring for hypertension by

March 2019.

Two Diabetes management pathways scoped and up to 20% increase in people

using My Diabetes My Way /self-management by March 2019.

Prevention and early intervention

6 organisations go live with a digital alarm receiving centre, supporting 1,000

people by March 2019.

Hub and cluster model for digital telecare established for 1,000 people by March

2019.

A Charter is in place by December 2018 that sets out the housing sector’s role in

technology enabled care and is supported by practice guides and case examples.

Early Intervention Mental Health

Sustainable, mainstream funding secured for the continued running and

development of cCBT by March 2019.

Remote access

Attend Anywhere embedded further into existing services, with a further 25

services targeted for implementation by March 2019.

Out of hours remote monitoring model in care homes has been tested and

reviewed by November 2018.

Enablers

Through Scotland Excel, a new procurement framework for telecare and telehealth

released.

Review into call monitoring and response services commissioned by September

2018.

National procurement for remote monitoring solution by October 2018.

An action plan to address barriers to local service transformation and scale up that

require action at national level is in place by November 2018

Funding is also identified of up to £1 million to support the development of the health

and care portal and digital platform which forms part of the wider Digital Health & Care

Strategy implementation plan. This is an essential enabler for scale up going forward.

Strategic Priority 3: Building capabilities & supporting improvement

Supporting Domain C and D: Digital Health and Care Strategy

Championing, supporting, gathering and promoting the evidence of what works, to

develop the culture and skills that recognise and use digital technology enabled care

including through developing business cases, supporting strategic planning and

delivery.


44. We have made important progress in achieving our ambitions in the adoption and

scale up of technology enabled care, and gained widespread acknowledgement of

the potential that it offers as part of change programmes. The recent study on

evaluation options has however highlighted the key importance of, and barriers to,

implementation: this includes the need for local leadership and support from those

involved in service delivery.

45. The lead role for workforce development and organisational development rests

elsewhere (primarily with NES and SSSC): the TEC Programme’s role is in

supporting that work, providing the content, including the evidence base, around

technology enabled care. Our focus will be on ensuring that is relevant, readily

available and useful. The TEC work going forward will support and contribute to the

wider delivery arrangements for Digital Health & Care Strategy, as well as the

development of a digital maturity framework for health and care services.

46. A key focus will be to look at what people need and value, and then to reshape and

supplement what we make available. This will include the creation of a central,

easily accessible repository of national and international information, case

examples, tools and evidence to be hosted by a new website for digital health and

care. The audience for this will be those using services and unpaid carers, as well

as service providers and commissioners.

47. The draft evaluation by Just Economics referred to above recommends that we

adopt the RRRP (Rapid, Relevant, Research Process) approach to evaluation and

provide more guidance and advice to those undertaking evaluations. A microsite is

proposed to host guidance documents and tools and sit as part of the wider

resources to support implementation of the Digital Health & Care Strategy.

48. Technology enabled care is an enabler, not a ‘thing’. Its potential to drive change

is widely recognised, reflected in the extent to which it is referenced in national

strategies and change programmes. We will focus time and effort in collaborating

with key partners and supporting national change programmes to use this

transformational potential.


Building Capabilities and Supporting Improvements

Awareness, knowledge, and skills about technology enabled care amongst those

commissioning and delivering health, care and support helps drive improvement

and transformation in health, housing & social care services

50. Associated ‘high level’ deliverables for this outcome are

Technology enabled care forms an integral part of all relevant national change

programmes and of workforce development in health and social care, with

technology enabled care expertise provided that adds value.

A central, easily accessible repository of knowledge and information resources

about becoming ‘ready and able’ to co-design and co-deliver local technology

enabled service improvement and transformation is available.

Capabilities are built by sharing experience gained and lessons learned between

Scottish and international stakeholders.

Technology enabled care data and evidence of what works is routinely collected

and analysed as part of service planning, improvement and delivery.


51. An early priority will be to agree specific inputs with other national change

programmes, where technology enabled care has been identified as a component

part. Our focus will be on agreeing the specific contribution alongside the added

value that is anticipated as a result of that input. We anticipate that this process

will also inform other work streams in the TEC Programme, such as the

information, evidence, tools and resources that can usefully be provided.

52. There is already a significant body of information and evidence along with tools and

other resources available about technology enabled care. It is however not all in

the same place, or always readily accessible. There is a need for a review to

identify gaps, shortcomings and updating requirements based on a clear

understanding of what partners and stakeholders need and value. This mapping

and review will be undertaken in the early part of 2018, so that it can inform the

development of a Communications and Engagement Action Plan that includes both

our national and international work.

53. We will continue to hold events prepare briefings and develop resources as the

Communications and Engagement Plan is developed. These will include both our

national and our international activities.

54. We are already aware that national and local partners are seeking improved data

and information to inform planning, commissioning and service development. We

will further develop approaches to data including tools such as our data

visualisation project with Strathclyde University and disseminate tools to support

local analysis for planning and service delivery such as the minimum data sets

developed in partnership with NHS NSS.

55. The study on evaluation options for technology enabled care undertaken in

2017/18 has provided valuable recommendations on areas for improvement.

During 2018/19 we will take forward these recommendations, particularly in relation

to developing a revised measurement framework for the Programme so that work

stream related evaluations use common definitions and collect certain core data,

enhancing our ability to identify themes across the Programme.

Deliverables in 2018/19 (budget circa £475,000)

Specific inputs to other national change programmes, where technology enabled

care have been identified as a component part, have been agreed by October

2018.

A TEC Communications and Engagement Action Plan has been developed by

December 2018.

The Digital Health & Care week and national conference and at least six learning

events have been held during 2018/19.

European and international engagement is progressed with at least six study visits, 10 webinars, and four joint events undertaken during 2018/19.

Two on line learning modules have been developed and made available to health and social care staff.

National on line learning network for ongoing support, learning and knowledge exchange is in place.

TEC data collection tools are in place by March 2019 to support local strategic and

operational planning for health and social care.

A revised measurement framework for the TEC Programme that responds to the

recommendations in the 2017/18 review of evaluation approaches and includes

project evaluations, benchmarking and regular data collection, is in place by

August 2018.

Successful delivery of the EU Third Health Programme funded project,

SCIROCCO, by November 2018, which will include Scotland’s participation in

twinning and coaching activities with other European regions to share experience

and learning in successful technology enabled care implementation that will inform

local system and service transformation.

Strategic Priority 4: Transforming local systems

Supporting Domains A, C, D and F: Digital Health and Care Strategy

Supporting exemplars that are seeking to transform local health and social care

systems using digital technology to shift local systems upstream to prevention and self-

management


56. This Strategic Priority parallels thinking in the Digital Health & Care Strategy, and

the TEC programme activities will complement and support this wider approach.

There are also important connections and associated opportunities with other

national priorities, particularly community empowerment and digital inclusion:

collaboration with other programmes will bring opportunities of skills exchange,

increasing capacity and the prospect of greater impact. Keeping the TEC

programme’s focus ambitious, but realistic and achievable, will be important.

57. Certain features are central to the TEC programme’s purpose in embarking on

system level change.

Service re-design incorporates technology as integral

Re-design embraces and delivers significantly greater opportunities for self-

management

Demonstrably greater support for carers has been delivered so that they can

continue their role for longer and with a better quality of life

There is a multi-sector focus and success in mobilising and using the assets

of the housing, independent and third sectors as well as health and social

care

Demonstrable improvement in key national indicators is delivered. The focus

here will be site specific, but is most likely to include reduced admissions to

hospital, lower care home stays, reduced level of care at home, reduced

dependence on medication, fewer falls, fewer visits to GP, greater self-

reported improvements in quality of life, and workforce related indicators.


Transforming Local Systems

The contribution that technology enabled care can make to transforming local

systems, particularly ‘upstream’ towards prevention and supported self-

management, is clear and pathfinder local partnerships are actively engaged and

delivering

59. Associated ‘high level’ deliverables for this outcome are

Exemplars illustrating the role and contribution of technology enabled care

services and supports are available for general use.

Local partnerships have access to clearly articulated local digital transformation

guidance by 2019 and advice developed from local exemplars ongoing.


60. The scale and focus of these pathfinders requires further discussion: they could

focus on a particular geography (a local community/locality, GP Cluster or GP

practice), a particular population (such as people with a long-term condition), or a

particular care pathway (such as respiratory), or some combination. It will not

however be on a single ‘service’, which would reduce the potential for

transformational change.

61. Work is already underway in Ayrshire & Arran, where an initial phase has focused

on development of a shared transformational vision for the respiratory pathway.

This is placing a self-managing service user in the driving seat of their own care,

able to access and work with a range of services that enable them to live as full a

life as possible at home. An initial phase has focussed on creating the conditions

for transformational change, developing an explicit theory of change supported by

an organisational development approach. This work will continue during 2018/19

to implement the pathway and explore wider transferability to other pathways and

geographical areas.

62. For the remaining programme, an initial period of discussion, such as in workshops

and innovation labs, will be undertaken both to generate interest in participation

and to shape the call for submissions. This will take place during the first half of

18/19 in close collaboration with other national programmes to achieve synergy. A

call for submissions with clear guidance will aim to identify between three and five

pathfinders by December 2018 in support of implementation of the Digital Health &

Care Strategy. The remainder of 2018/19 will be focused on supporting the set-up

of these pathfinders.

63. During 2018/19, a ‘formative’ evaluation will also be commissioned around these

pathfinders. This type of evaluation ensures that the learning from the early stages

can inform the project’s design and performance, as well as making sure that

learning can be made available more widely.

Deliverables in 2018/19 (budget circa £800,000)

Between three and five pathfinders identified by December 2018 in support of implementation of the Digital Health & Care Strategy

Formative evaluation commissioned around pathfinders by March 2019

Conclusion

64. The TEC Delivery Plan sets out high level and specific deliverables in the context

of the TEC strategic priorities and the Digital Health & Care Strategy objectives.

The associated budget is set out in Annex 1. The Delivery Plan builds on the work

to date (since April 2015) with a well-established programme and collaborations

with delivery partners in place. The scope and pace of work will further evolve in

the context of the Digital Health & Care Strategy but the TEC contribution is being

clearly set out to support the wider implementation plan.

65. The deliverables and associated measures will be kept under review to ensure a

balance between reasonable ambition and ability to deliver. As has been the case

to date, the learning from implementation will inform next steps and regular

updates will be provided to the Board along with a revised measurement

framework.

66. The overall work and approach of TEC to date is well positioned to support the new

Digital Health and Care Strategy. In particular the focus on National Direction

(Domain A) will ensure that TEC is integrated as a key contributor to the national

approach being taken forward building on the strong collaboration with national

partners. Specific contributions across the Strategy Domains are referenced in this

delivery plan and will be further developed over the next year. Additionally TEC will

inform some key aspects of Domain F – the Transition Process.

Dr Margaret Whoriskey

Director TEC Programme

technology enabled care supporting service transformation ... · technology now needs to transform...

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