Telehealth in SouthamptonTelehealth in Southampton

Mr C WebbMr C Webb

Brief CVBrief CV

• Mental health nurse and CPN (1976 – Mental health nurse and CPN (1976 – 1989)1989)

• Mental health service manager - Mental health service manager - community and in-patients (1989 – 2002)community and in-patients (1989 – 2002)

• Social services (2002)Social services (2002)• PCT long term conditions and equipment PCT long term conditions and equipment

manager (2002 – 2011)manager (2002 – 2011)– COPD, cardiac, diabetes, continence, stomaCOPD, cardiac, diabetes, continence, stoma– Equipment, wheelchairsEquipment, wheelchairs– Telehealth & telecareTelehealth & telecare

Location

Southampton informationSouthampton information

• 240,000 population (12% over 65)240,000 population (12% over 65)• Centres of deprivation (91Centres of deprivation (91stst out of 354, out of 354,

44thth most deprived in SE England) most deprived in SE England)• 37 GP practices37 GP practices• Large acute teaching hospitalLarge acute teaching hospital• 86,000 people with a LTC86,000 people with a LTC

– Includes COPD/asthma, CVD & hypertension, diabetes, Includes COPD/asthma, CVD & hypertension, diabetes, epilepsy & all severe mental illnessepilepsy & all severe mental illness

• 28,000 on hypertension registers28,000 on hypertension registers• Unconfirmed 4000 people with COPD Unconfirmed 4000 people with COPD

Solent NHS TrustSolent NHS Trust

• £177 million£177 million

• 4,200 staff4,200 staff

• 2 cities – Southampton & Portsmouth, and 2 cities – Southampton & Portsmouth, and elements of the South of Hampshireelements of the South of Hampshire

• £25,000 core telehealth budget £25,000 core telehealth budget (Southampton only)(Southampton only)

• Manage all telecare work for Southampton Manage all telecare work for Southampton City Council and partially in PortsmouthCity Council and partially in Portsmouth

Drivers for changeDrivers for change

• Personal interestPersonal interest• EU project applicationEU project application

• Budgetary pressures on staff and Budgetary pressures on staff and resourcesresources

• Increasing frailty & LTCs increased Increasing frailty & LTCs increased numbers and diagnostics in the populationnumbers and diagnostics in the population

• Shortening of acute admissions and desire Shortening of acute admissions and desire for more community carefor more community care

UsesUses

• Anything that needs monitoring!Anything that needs monitoring!– COPDCOPD ✔✔(full usage)(full usage)– CardiacCardiac ✔✔(heart failure)(heart failure)– ContinenceContinence ✔✔(monitoring between clinics)(monitoring between clinics)– AsthmaAsthma ✔✔ (paediatric)(paediatric)– PodiatryPodiatry ✔✔ (wounds between visits)(wounds between visits)– Leg ulcersLeg ulcers ✔✔(size of wounds)(size of wounds)– DiabetesDiabetes– PainPain– Terminal careTerminal care

Telehealth in the Solent’s Community COPD TeamTelehealth in the Solent’s Community COPD Team

• The main project aims were:The main project aims were:– To increase the use of telehealth within To increase the use of telehealth within

the Community Chronic Obstructive the Community Chronic Obstructive Pulmonary Disease (COPD) Team, Pulmonary Disease (COPD) Team,

– To explore how the team could work To explore how the team could work differently to provide an effective service differently to provide an effective service

forfor an increasing number of patients an increasing number of patients with this condition. with this condition.

• To measure the efficacy, benefits and cost effectiveness of the To measure the efficacy, benefits and cost effectiveness of the technology in supporting patients with COPD. technology in supporting patients with COPD.

• To examine the impact of telehealth on patient experience and To examine the impact of telehealth on patient experience and quality of life quality of life

• To review whether the technology improves the ability of the patient To review whether the technology improves the ability of the patient to self manageto self manage

Over 100 Over 100 Docobo Docobo

HealthHUBS are HealthHUBS are in use in use Additional aims

• Avoided admissionsAvoided admissions: : 242 242 to the acute sector (Oct 09 to to the acute sector (Oct 09 to May 11). May 11).

• Improved data collection and data content :Improved data collection and data content :

• AA richness of data richness of data

• A greater understanding A greater understanding of a patient’s condition of a patient’s condition

• Earlier intervention Earlier intervention in exacerbation in exacerbation

• AnAn enhanced service without increasing enhanced service without increasing the number of the number of clinical staff. clinical staff.

• An improved seamless pathway An improved seamless pathway with allied community with allied community staff and general practice, to provide a more sustainable staff and general practice, to provide a more sustainable serviceservice

• ImprovedImproved patient experience patient experience of the service of the service

• IncreasedIncreased quality of life quality of life for both themselves and their for both themselves and their carers, feeling carers, feeling more supported and connected more supported and connected to the to the teamteam

• Improved knowledge:Improved knowledge: supporting the patient to learn supporting the patient to learn more about their condition more about their condition

Outcomes

Benefits 1Benefits 1

Patients / clients /carersPatients / clients /carers

• ContentmentContentment

• Knowledge and Knowledge and awarenessawareness

• Reduction in Reduction in inappropriate inappropriate admissions and GP admissions and GP attendancesattendances

• Reduction in Reduction in dependency and dependency and institutionalisationinstitutionalisation

StaffStaff

• Improved informationImproved information

• Improved work Improved work planningplanning

• Reduced travelReduced travel

• Appropriate visits / Appropriate visits / clinicsclinics

• Improved satisfactionImproved satisfaction

Benefits 2 - overallBenefits 2 - overall

• Reduction in admissions to hospitalReduction in admissions to hospital

• Reduced costs Reduced costs – More patients managed, same staff complementMore patients managed, same staff complement– Reduced travel costsReduced travel costs– Cheaper alternative & earlier treatments (at home)Cheaper alternative & earlier treatments (at home)

• ‘‘Green issues addressed’Green issues addressed’

• Patients able to ‘do’ more for Patients able to ‘do’ more for themselvesthemselves– Peer supportPeer support– SocialiseSocialise– Potential to work longer or againPotential to work longer or again

Barriers to changeBarriers to change

• FinanceFinance– For equipmentFor equipment– From savings elsewhereFrom savings elsewhere

• Information governanceInformation governance– Sharing across organisations and even internallySharing across organisations and even internally

• CultureCulture– Traditional working and clinical pathwaysTraditional working and clinical pathways

• StaffStaff– Mistrust of ‘NHS IT’Mistrust of ‘NHS IT’– Fear for jobsFear for jobs

Planning for developmentPlanning for development

• Examine existing clinical & care pathways to consider Examine existing clinical & care pathways to consider where innovative technology (telehealth and telecare) can where innovative technology (telehealth and telecare) can be used.be used.

• Re-align working practice to use telehealth & telecare.Re-align working practice to use telehealth & telecare.

• Work with commissioners to re-align finance alongside the Work with commissioners to re-align finance alongside the new clinical and care pathways.new clinical and care pathways.

• All staff to be trained in the uses of telehealth and all new All staff to be trained in the uses of telehealth and all new referrals to be assessed for telehealth via an ‘exclusion referrals to be assessed for telehealth via an ‘exclusion policy’.policy’.

• A range of telehealth and telecare to cover as many patient A range of telehealth and telecare to cover as many patient groups as possible, (simple and complex)groups as possible, (simple and complex)

• Link with Single point of access and virtual ward case Link with Single point of access and virtual ward case managementmanagement

• Purchase (100) additional units for the next expansionPurchase (100) additional units for the next expansion

Future aspirationsFuture aspirations

• Telehealth & telecare systems link Telehealth & telecare systems link across NHS, housing and social careacross NHS, housing and social care

• Central monitoringCentral monitoring

• Case management via central Case management via central information centreinformation centre

• Assessors, therapists work directed Assessors, therapists work directed via information and technologyvia information and technology