The King’s Fund/University Medical Centre UtrechtInternational Congress on Telehealth & Telecare

KEEPING IT SIMPLE IN SCOTLAND

Moira MackenzieJoint Improvement Team, Scottish Government

Impending Doom? Or Opportunity?

Durer: The Four Horesment of the Apocalypse

A vision of the future?

Kirsty McGregpr of Community Care http://www.communitycare.co.uk/static-pages/articles/into-the-virtual-future/ Dec 2010

Telecare & Telehealth in Scotland: Background> Launch of both activities in 2006> Different approaches adopted e.g. funding, facilitation

& support, evaluation> Small to medium projects but generally unconnected

local/national developments> Confusion around terminology and accountabilities> Huge enthusiasm and ministerial support> Good progress made to date

Progress to Date: Telecare£20m development programme and facilitation providedby SGAims:to help more people in Scotland live at home for longer, with safety and security, by promoting the use of telecare.

provide the foundation on which telecare can become an integral part of community care services across Scotland

Initial Objectives Increase number of telecare service users to 75,000 by

2010, including 9,000 with a diagnosis of dementia Reduce avoidable admissions to care homes, and of

unplanned admissions and readmissions to hospital Reduce the need for more expensive forms of

intervention Reduce the pressure on carers Improve quality of life for service users

Measuring Progress Initial expectations set out in business case (2006-8) Telecare Strategy (2008-10) Subject to considerable monitoring & review since outset

Gateway Review 2007York Health Economics Consortium Evaluation 2008Quarterly Returns from PartnershipsAnnual Progress Reports – Newhaven Research

Contributions to other research e.g. Leeds University 2009, feedback from other evaluations

Telecare Action Plan to 2012

Progress Across Scotland (Mar ‘10) Approx 180,000 people with

telecare services in Scotland All 32 local partnerships making

progress 29,117 people have received a

telecare service as a result of TDP, over 2,000 with dementia diagnosis

Approx £10m of TDP funding had been spent out of total £14m allocated (75%) at end March

Indicative gross benefits estimated £48m

Continuing positive feedback from Carers/Service Users

Source: Newhaven Research (2010)

Outcomes Partnership Expectations

Partnership Achievements

Reduction in delayed discharges from hospital 967 611Reduction in the number of unplanned hospital admissions 1,088 2,793Reduction in the number of care home admissions 2,036 1,190Number of persons able to maintain themselves at home throughreceipt of a telecare service (2009/10 quarterly average) 10,085

Efficiencies Partnership Expectations

Partnership Achievements

Number of hospital bed days saved due to reduction in number of delayed discharges 10,674 7,013Number of hospital bed days saved due to reduction in number of unplanned hospital admissions. 10,922 23,747

Reduction in number of care home bed days purchased 43,313 205,308

Number of nights sleepover care saved 16,902 12,895

Number of home check visits saved 85,778 50,472

Progress Monitoring Results 2009/10

Innovation & Integration Demonstrators Monitoring ‘Health at Home’(A&B, Lanarkshire, Lothian) Preventing & Managing Falls(Falkirk, P&K, South Ayrshire) Development of local training

& Awareness Raising Programmes

(Fife, Edinburgh, Falkirk/FV) Housing & Care Models(Highland, Inverclyde, West Lothian) Promotion of telecare across

different user groups

Progress: TelehealthHealth Boards prompted to fund telehealth via annual allocations. A Scottish Centre for Telehealth was established as Advisory Body within NHS Scotland

Aims- Facilitate the introduction of national telehealth services- Assist health boards with telehealth pilot projects

Progress across Scotland (Apr 2010)Telehealth> Significant Stroke Management &

Paediatrics Programmes> Support provided to Health

Boards in their Telehealth projects

> Awareness Raising> Review of SCT progress

undertaken and move into NHS24 now complete

> Telehealth Champions Network Launched in 2010

> Strategic Framework for Telehealth published to 2012

Criteria used for identification of services for national roll-out

> Economics (cost effectiveness)> Practicability> Conformity with government

objectives> Severity of disease> Service profile> Net cost to NHS Scotland

Telehealth Priorities to 2012 4 National Programmes:

stroke, paediatrics, mental health & COPD/Pulmonary Rehab

Underpinning Activities:Technology standards, Education & training, Stakeholder engagement, Convergence with telecare

Challenges Need for more co-ordinated strategy, leadership and

investment at both local & national level, which actively addresses our wider service pressures & priorities

In some areas there is still a project mentality instead of seeing a significant service redesign opportunity

Equipment and data integration yet to be resolved Initially slow but gathering momentum – huge enthusiasm

from carers and practitioners working with the technology Telehealth & Telecare at different stages, and need for

integrated community based services & care pathways

Joining it all together Phase 1 (2006-9): Raise

awareness/develop local & national expertise

Phase 2 (2010-12): Joint strategic drive, strengthen underpinning infrastructure & expand/integrate national programmes (90% roll-out/10% innovation) = Robust Platform

Phase 3 (2013-15): Health & Social Care integration. Increase scale of development to inform national expansion. Increase innovation/data integration & analysis.

Expansion

Innovation

An incremental approach to change

Implementing joint governance and reporting framework, linking to wider agenda

Merging Telecare & Telehealth under NHS 24 from April 2011

Integrated Education and Training approachDeveloping detailed proposals for 2013

onwards which inform integrated health and care models

Ongoing capture and review of experience

and finally … The Evidence Challenge

Good evidence for good outcomes Good evidence for efficiencies and savings

BUTMultiple claims for the same savingsReal or notional savings?Gross or net savings/costs?

Conclusion – Must be ‘whole system’ Must be “greater than the sum of the parts”

And it has to be done to generate any evidence!

The Wright Brothers 1903