Welcome

1. Welcome The Victoria Park Plaza Hotel Victoria London

2. Chair’s Welcome Richard Humphries Chief Executive Care Services Improvement Partnership

3. The Gift of Peace of MindLiam Byrne MPParliamentary Under Secretary of State for Care Services

4. For printed copies of each presentation please complete the Conference Evaluation sheet (in the handout pack) at the end of the day and hand it to the conference registration desk

5. Health & Social Care Change Agent Team STRATEGIC COMMISSIONING OF SERVICES AND THE BENEFITS OF INVESTING IN TELECARE LONDON Tuesday 19 July 2005

6. Health & Social Care Change Agent Team ARE YOU READY TO SPEND THE £80 MILLION? Ian Salt C.S.I.P. National Lead - Telecare

7. Health & Social Care Change Agent Team “In looking at the new funding, as a Director of Social Services I might be asking myself……..” • Is there any evidence for telecare – is it cost-effective? • How do I deal with the ethical issues like consent? • How do I get Social Services, Health, Housing and the independent sector involved in improving services? • How does telecare fit in with other plans and priorities for promoting independence and dignity? • How does telecare become a mainstream service?

8. Health & Social Care Change Agent Team “Is there any evidence for telecare – is it cost effective?” • Examples of good practice and innovation showing that telecare can help reduce care home and hospital admissions and support independence programmes • Innovativehousing schemes have led the way in providing telecare support • Payment by Results and the National Tariffopportunities for PCTs to monitor long term conditions outside of hospital • The CSIP Telecare Implementation Guide and factsheets provide information, checklists and contacts including local services and telecare experts

9. Health & Social Care Change Agent Team “How do I deal with the ethical issues like consent?” • Users could benefit from telecare • Care should be taken to obtain consent and agreement • Follow-up, monitoring and review will ensure that telecare meets the needs of users and is not intrusive • Complex situations will need special consideration • Innovative work would need local ethics committee consideration – a factsheet is available

10. Health & Social Care Change Agent Team “How do I get Social Services, Health, Housing and the independent sector involved in improving services?” • ICES Section 31 or other existing partnerships to bring people together – this could leverage in extra funding • Users may have reduced hospital admissions and those supported by health services may need less care,– whole systems thinking is vital • Telecare could provide considerable benefits for carers and families • Fair Access to Care Services and Single Assessment will enable services to be focused on users and carers

11. Health & Social Care Change Agent Team “How does telecare fit in with other plans and priorities for promoting independence and dignity?” • Audit Commission and the Health Select Committee reports • The Green Paper on Adult Social Care includes telecare • Standards in several of the NSF’s could be achieved using aspects of telecare ( long term conditions, falls strategies, intermediate care ) • Telecare could support people as part of palliative care programmes • ‘Improving the Life Chances of Disabled People’ has many references to assistive technology

12. Health & Social Care Change Agent Team “How does telecare become a mainstream service?” • Innovation and programme evaluation identifies the value of telecare services with a sound evidence base and demonstrates value for money • Partnership working provides synergy and leveraging of additional, recurring funds to provide long term development • A viable service option for health, housing and social services provision with clear links to their strategies, policies, commissioning plans and service priorities • Involving users and carers through consultation and care planning focuses on independence, dignity and choice • The CSIP Guide and factsheets support local plans

13. Health & Social Care Change Agent Team Implementation of telecare Project Mgr Awareness Suppliers Procurement Ethics Contracts/SLAs Protocols Pilot(s) Commence Charging Review FACS, SAP

14. Health & Social Care Change Agent Team Implementation of telecare Project Mgr Suppliers Ethics Pilot(s) Charging FACS, SAP Awareness, training Funding >Procurement Contracts/SLAs Protocols Commence Review

15. Health & Social Care Change Agent Team Implementation of telecare – too long Project Mgr Suppliers Ethics Pilot(s) Charging FACS, SAP Awareness, training Funding >Procurement Contracts/SLAs Protocols Commence Review 6 months 6 months 6 months 6 months 6 months

16. Health & Social Care Change Agent Team Implementation of telecare – telescoping the timeline using the Guide and Factsheets Telecare Champion Funding and 2005/6 Plans Evidence-base, suppliers, procurement Partnership working Ethics FACS, SAP, fairer charging Awareness, training Contracts/SLAs Protocols Commence Review July 2005 Dec 2005 April 2006 Sept 2006

17. Health & Social Care Change Agent Team SO - ARE YOU READY TO SPEND THE £80 MILLION? We need to share information as it starts to emerge We need to gather evidence so that we can move this telecare agenda forward together. Ian Salt C.S.I.P. National Lead - Telecare

18. Health & Social Care Change Agent Team FOR MORE HELP AND ACCESS TO THE CSIP TELECARE IMPLEMENTATION GUIDE PLEASE VISIT OUR WEB SITE: www.icesdoh.org/telecare www.changeagentteam.org.uk/telecare Thank you Ian Salt

19. For printed copies of each presentation please complete the Conference Evaluation sheet (in the handout pack) at the end of the day and hand it to the conference registration desk

20. Getting the Right Balance of Care in your Economy ‘Strategic Commissioning of Services and the Benefits of Investing in Telecare’ Workshop 19 July 2005 Steve Arnold Director, Integrated Care North West London SHA

21. Long Term Conditions: • are enduring • are not curable and require ongoing care • will get progressively worse What’s included?: • arthritis, diabetes, heart failure, COPD • mental health • renal dialysis, cancer and HIV/AIDS • Sickle Cell and Thalassemia • NSF on Neurological Conditions

22. The challenge …. • 17.5m people with LTC, 8m with multiple LTCs • Discomfort and stress an everyday reality • Care has been reactive, unplanned and episodic, reliant on hospitals • 5% LTC inpatients = 42% of all acute bed days • LTCs account for 80% of GP attendances • Only 50% medicines taken as prescribed

23. Strategic Aims • Embed a systematic approach across health and social care • Reduce reliance on secondary care – increase primary, community and home support • Deliver high quality personalised care • Support for self-care – linking to ‘Choosing Health’ and healthier choices

24. National Targets • April 2008 - reduce Emergency Occupied Bed Days by 5% • April 2008 - identify the cohort of Very High Intensity Users - est. 240k nationally • April 2008 – all VHIUs have care plans and are case managed • April 2007 – complete appointment of Community Matrons - 3,000 nationally

25. Case Management Highly complex Patients (5%) Level 3 Disease Management High risk Patients (15%) Level 2 Supported Self Care Low risk Patients (80%) Level 1 POPULATION WIDE PREVENTION Stratifying need and matching care

26. ‘Supporting People with Long Term Conditions – An NHS and Social Care Model’(Jan 2005)

27. Albert’s story ….. present day • Albert is 72, lives alone - diagnosed with COPD 15 years ago • 30% of normal lung function at rest - severe breathlessness especially when he exerts himself, even in the most routine ways • underweight; anxious, depressed, prone to panic; he feels hopeless and that he can’t cope •  regular exacerbations - admitted to hospital - 15 days LOS • delay in notifying the GP and in getting support - re-admitted to hospital • not able to attend the follow-up OPD appointments offered at the hospital • GP does not normally visit • treatment - oxygen therapy, steroids, antibiotics and regular use of inhalers, although he would often forget to take his medication • meals delivered - carer support

28. Albert’s story ….. 2010 • Co-ordinated by Primary Care Centre - Nurse Case Manager contacts him regularly both by telephone and in person • Provides routine information daily through a hand held computer to the PCC - assessed daily • Contact him by video link re possible exacerbation - advice about additional self-medication • Other reports, inc weather conditions • Urgent visits as appropriate • Admissions to hospital reduced – and then: •   PCC stays in touch • LOS reduced - usually 3 to 4 days • Co-ordinated discharge •  ‘Direct payments’ funds gardener • Calmer and spends lots of time admiring his newly reclaimed garden.

29. Lessons for the Telecare agenda • Whole systems approach • Links to the broader policy agenda • Staff training inc decision support • Awareness raising amongst users • What can the industry contribute?

30. Long Term Conditions – take home message Be ambitious – this is about transformation

31. REFRESHMENTS For printed copies of each presentation please complete the Conference Evaluation sheet (in the handout pack) at the end of the day and hand it to the conference registration desk

32. Newham Home Monitoring Project : Using Telecare to Integrate Health and Social Care

33. About Newham

34. About Newham • Ranked 4th in Jarman scores • 62% of population are from black and ethnic minorities • High proportion of under 24s • Significant population growth forecast

35. Health in Newham • Major areas of health inequality • Significant burden of long term conditions particularly diabetes, cardiovascular disease and respiratory disease • Age profile of LTCs different • Huge potential for improvement

36. Mortality trend for coronary heart disease, in people aged under 65

37. Mortality trend for stroke, in people aged under 65

38. A Relatively Small Number of PatientsAccount for a Large Share CostsHospitalized Patients and % of Total Patient Days Percent of Total Percent of Total 86% 74% Hospitalized Patients Total Patient days Hospitalized Patients Total Patient Days All London Newham PCT

39. What works in LTC management ? • Managing the whole package of needs • Single point of contact, particularly to promote good cross sectoral and multidisciplinary working • Good quality, accessible information • Proactive management • Timely, effective and proportionate response in and out of hours • Involved and informed patients and carers • Tailoring to individual needs, especially in complex cases

40. Aims of the Home Monitoring Project • Increase patients’ knowledge of their condition • Identify risk factors/ deteriorating condition and intervene early • Increase access to information 24hrs a day for health & social care professionals caring for the patient • Manage health & social care needs and patient anxiety

41. Target Group • Older people living at home beginning to develop a pattern of regular admissions / attendance at A&E • At least one chronic condition • Anxious / socially isolated and in need of support • Those with language needs and early stage cognitive impairment actively involved

42. What the project consists of Single Assessment Risk Identification Care Companion Web Record Case Manager based in Local Authority Call Centre Individual Escalation Protocol

43. AMD Care Companion System Assessment Unit + wireless devices Assessment Unit Assessment Unit + wireless devices + videophone

46. Potential Value of Telecare • Extend care to home setting • Supports patient education and concordance • Relieves pressure on carers • Integrates in and out of hours care • Facilitates proactive care • High quality reliable information for decision making • Underpins information sharing and joint planning • Enables most effective use of health / social care resources

47. Lessons Learned in Newham • Steep learning curve for NHS and independent sector • Dedicated resources essential • Compatibility between systems needed • Risk issues (clinical, financial) • Enthusiasm from staff and patients

48. For printed copies of each presentation please complete the Conference Evaluation sheet (in the handout pack) at the end of the day and hand it to the conference registration desk

49. Telecare A Durham Perspective

50. Content • Part One (John Thornberry) • We like telecare because • There are challenges • Our strategic approach • Part Two (Dennis Scarr) • Pathfinder programme • 3 examples