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TKN -THE WAY FORWARD A CLINICIANS PERSPECTIVE

TKN -THE WAY FORWARD A CLINICIANS PERSPECTIVE. Dr Beverly Castleton Consultant Physician, Surrey PCT 9 th February 2007. Introduction Model of Care – CDM – “Out of Hospital” Pilot to Practice – Mainstream Telecare WSD – Other DOH initiatives SAP – CAF – eSAP/CAF

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TKN -THE WAY FORWARD A CLINICIANS PERSPECTIVE

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  1. TKN -THE WAY FORWARDA CLINICIANS PERSPECTIVE Dr Beverly Castleton Consultant Physician, Surrey PCT 9th February 2007

  2. Introduction • Model of Care – CDM – “Out of Hospital” • Pilot to Practice – Mainstream Telecare • WSD – Other DOH initiatives • SAP – CAF – eSAP/CAF • Technological developments • Evaluation and Commissioning • Conclusion

  3. MODEL OF DELIVERY FOR CHRONIC DISEASE • Out of Hospital • Single Assessment Process Delivery • Common Assessment Framework • Risk Management • Reshaping Patient-Centred Care • White Paper – Our health, our care, our say • A New Ambition for Old Age

  4. RISK STRATIFICATION Managed care in the community and hospital settings covers all levels of the triangle Highly complex patients Case Management High risk patients Disease Management Supported self-management 70-80% of people with chronic conditions Population-wide prevention

  5. TELECARE DEFINITION Telecare is the delivery of health and social care services to people usually in their own homes using a combination of sensor and information and communication technologies (ICT).

  6. COLUMBA LESSONS LEARNT 1997 - 2006

  7. TELECARE Prevention Safety & security monitoring, e.g. bath overflowing, gas left on, door unlocked Mitigating risk Information & Communication, e.g. health advice, triage, access to self-help groups Personal Monitoring: Physiological signs Activities of daily living The individual in their home or wider environment Prevention Improving functionality Electronic assistive technology, e.g. Environmental controls, doorsopening/closing, control of beds

  8. THE EMERGING INFRASTRUCTURE The individual in their home • Assessment & referral • Equipment • Monitoring • Response • Review NCRS Alarm ! Record event Response protocol Response: home visit, emergency services, remote change Check status Check Response provider: neighbour, relative, ambulance, HCA, fire, police Call centre

  9. LOGISTIC & INFORMATION PATHWAY OF A TELECARE SERVICE Entry (Re) Assessment of Need (SAP) Care Package Development Review Telecare Prescription and a Response Protocol Community Response Homesurvey Call Handling Monitoring Equipment Provision Installation and Maintenance

  10. PARTNERS IN PROVISION • Intermediate Care/Older Peoples’ Services • Dementia Care • Falls Services • Primary Care – GP/DN/Out of Hours • Community Alarm Service • Ambulance Service • ANPs (Advanced Nurse Practitioners) • Community Matrons • SWOPs (Specialist Workers for Older People) • Specialist Nurses in Chronic Disease Management • Patients, Carers and Relatives • Home Care?

  11. PARTNERS IN PROVISION • Flexible Systems • Quality • Not necessarily hours

  12. TELECARE IS AN ADJUNCT TO THE SYSTEM NOT A SUBSTITUTE FOR CARE AND HANDS-ON DELIVERY

  13. 3 MIGRATION PATHWAYSREDESIGN IT Asst Interagency Skills Work Integration Clinical Networks Whole System Delivery

  14. TRUSTED ASSESSOR TRAINING

  15. CONTEXT • At least 12 major government reports since 1998 have called for telecare • Delivering 21st century IT support for the NHS: ‘home telemonitoring’ to be available in 100% of homes requiring it by Dec 2010 • £80m in Comprehensive Spending Review for developing telecare and social alarm services • The elements of a telecare framework are in place – NCRS, social alarm service, ICES • Numerous trials shed light on implementation problems and individual outcomes

  16. TECHNOLOGY IMPACT • Reduces patient journeys, hospital visits and hospital admissions • Saves the time of healthcare professionals • Supports individuals living at home to look after themselves • Improves the quality or effectiveness of the care or treatment that is delivered • Helps to manage the risk

  17. TELECARE – The Challenge • Limited mainstream telecare in England as yet, no joint commissioning – telecare not provided as a ‘care option’, what happens with practice-based commissioning? • 150 SSDs, 152 PCTs, 238 DCs, housing assns, alarm providers would need to be involved in assessment and care planning via SAP/FACS etc with information sharing • Who is the client? • Who pays?

  18. TELECARE – The ChallengeMainstreaming • Creating the organisational structure for implementation • Retraining staff • Apportioning costs • Deciding eligibility • NEEDS IT BACK UP TO IMPROVE INFORMATION FLOW

  19. PTG • Walton Community Hospital Project – Physically & mentally frail patients Ward multi-disciplinary Teams Telecare Assessor – Team Member • Multi-disciplinary Assessment Panels (MAPS) Community based Very complex frail elderly

  20. SINGLE ASSESSMENT PROCESS • Common Assessment Framework • Who Leads? • What Criteria? • All Levels of Need

  21. “There is the tantalising possibility for public policy to meet more people’s desire to remain independent for longer, while at the same time saving money overall” Source: “Assistive Technology – Independence and Well-being 4” Audit Commission, Feb. 2004

  22. CORE PROCESSES FOR CHRONIC DISEASE MANAGEMENT • Involve the patient and customise for their needs • Easy access • Manage populations through integrated databases – screen and risk manage • Develop robust networks between: - patients (support groups) - patients and professionals (communities of care) - professionals (communities of practice)

  23. CORE PROCESSES FOR CHRONIC DISEASE MANAGEMENT • Training and development for patients and professionals • Develop expert systems: - expert patients - expert professionals - expert ICT with protocols, guidelines etc that develops shared knowledge • Clinical governance that depends on good evaluation and the ability to track the patient in the system

  24. MAJOR SWOP/STOP NETWORKS A&E MAU Wards Specialist based assessment SWOP System Rehabilitation Community Social Services Information, skills flow

  25. PARKINSONS DISEASE MANAGEMENT Primary Care Team PD Society Day Resource Unit Pt with PD Geriatrician Neurologist EPICS/Comm. Matron PDLN Home Care? Arrows indicate flows of information, skills and care

  26. THE PARKINSON’S DISEASE SUPPORT NETWORKNew Electronic Support Network for People with Parkinson’s Disease • A collection of linked websites, or “virtual communities” to help patients, their families and healthcare professionals to support sufferers of Parkinson’s Disease • Medixine/North Surrey PCT/Imperial College, London

  27. KEY ISSUES • Who is offered Telecare? • What levels of sophistication of equipment? • Do we need national criteria? • Should the equipment be free? • Should the revenue cost be means tested? • Should it be disease led?

  28. DEPARTMENT OF HEALTH • Long-term conditions • CAF & Care Planning • e SAP/ e CAF • NSF’s • A Recipe for Care – Not a Single Ingredient

  29. WANLESS Social Care ReviewImpact of Telecare on the need for Domiciliary Care,*2005/6 to 2014/5 Hours of care (thousands) *Potential impact of the 2006-08 Preventative Technology Grant investment on the estimated number of hours of domiciliary care needed in Telecare Valley (excluding care homes).

  30. The provision of telecare has an immediate impact on total staffing levels. When assessing staffing, it is not only formal carers who need to be included, but also the call centre staff and response teams on which telecare networks crucially depend. The demand for staff is particularly high at the beginning of a telecare investment project when this human infrastructure needs to be set up, the telecare equipment installed and everyone trained to use it.

  31. TECHNOLOGY MOVES ON Digital TV Flexible Platforms for Chronic Disease management delivery Frailty Registers Compliance improvement

  32. CONCLUSIONS • Major Service Redesign • Whole System Integrated Approach • Use the IT Agenda as a catalyst for change • Single Assessment Process to mainstream Telecare • Cross Organisational Workflow and Workforce required • Managing the Risk is essential • Patient and Carers need to be part of the team • Accuracy of Data essential • Win Win

  33. CONCLUSIONS TELECARE CAN • Postpone and divert people from RH/NH • Reduce the need for hospitalisation • BUT • Need robust data for reapportioning costs • Lets resist short-termism getting in the way • Telecare is a useful adjunct to care • Needs to be part of a care prescription to reduce routine tasks and improve quality and flexibility of Care Delivery at Home

  34. Research & Evaluation & Commissioning

  35. PAYOR DATA PATIENT (& CARER) PROVIDER

  36. REFERENCES • Audit Commission, Assistive Technology: Independence and Well-being 4, February 2004 • Audit Commission, Older people – implementing telecare, July 2004 • Department of Health, Building Telecare in England, July 2005 • Department of Health Health and Social Care Change Agent Team (CAT), Housing LIN Factsheet no 5 – Assistive Technology in Extra Care Housing, August 2004

  37. REFERENCES • Department of Health ICES (Integrating Community Equipment Services, Telecare Implementation Guide and numerous fact sheets, July 2005 onwards • Health Select Committee, The Use of New Medical Technologies within the NHS, Fifth Report of Session 2004-05, April 2005 • Department of Health Application of Telecare and Long Term Care • Telecare Alliance, Website address:www.telecarealliance.co.uk • Wanless Social Care Review, King’s Fund, 2006

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