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The Social Care Battleground

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The Social Care Battleground Powered By Docstoc
					    Telecare in Wales
             Lee Davis
        Welsh Government
            07808 727466
            029 2080 1410
      Lee.Davis@Wales.GSI.gov.uk


www.ssiacymru.org.uk/telecare
Why is there so
little Telehealth
         ?
                       Wales

• Population under 3 million
• 22 Local Authorities

• 7 LHBs
• All Co-Terminus with one or more local authority

  So :
• Regionalisation
• Pooled Budgets
     Welsh ‘Call Centres’ In 2006
• 22 (23?) call centres mostly only 5,000
  connections
• Only one with over 10,000 connections
• Every LA had one
• Costs not known
• Value not known
• Potential not understood
               Regionalisation

• North Wales Regional Telecare Service
• 6 local authorities and one LHB working through one
  call centre (admittedly on two sites)

• South East Wales Improvement Collaborative (SEWIC)
• 10 Local Authorities and 3 LHBs
• Encompassing Gwent Frailty Project

• Carmarthenshire & Hywell Dda RCT
        Sustaining Social Services – A
           Framework for Action

•   Regionalisation
•   Cost
•   Integration of Telecare & Telehealth
•   Links with ICES
       Telecare to Manage Risk
Environmental
                           Social             Medical
And Security


                                            Cardiac arrest

          Flood     Nutrition   Cognition
Fire
                                             Medication



Gas
        Intruders          Mobility         Asthma attack
      A Robust Business Case !?


A telecare enhanced care package is on average
 cheaper to social services than residential care
  only if the package is less than about 20 hours
                    per week…
     A Robust Business Case !?

             Random Sampling:

Where institutional care is avoided social care
 costs were on average reduced by £216 per
                     week
 Where telecare can mean a reduced care
  package at home the cost avoidance is on
            average £257 per week
       A Robust Business Case !?

                 In one county studied:

Weekly cost of providing telecare service is under £9 per
      user per week – elsewhere probably £12-£15

                     Across Wales:

On average 3.29 hospital bed days per year per client – a
            weekly saving of £14.12 per client
     John Bolton’s Work for SSIA
• List of 31 things that local authorities should
  do to save money

• Telecare is Number 2 on that list

• After Re-ablement ( – which it can support)
      A Robust Business Case !?

                   Conclusion

The potential for a well targeted telecare service
       to reduce costs for social services is
                    substantial
    A Robust Business Case !?

                  Conclusion

      Telecare is not a cost saving panacea
  Telecare was developed to manage the risks
associated with independent living, to contribute
to people’s health, mobility, social well-being and
    security, and ultimately to provide choice

      This should remain its primary goal
People Receiving Telecare at midnight
        on 31December 2009


                   17,946
       Total Telecare Service Delivery = 19,699

     Community Alarm users = 100,000 approx
Home Care Service Users in any given week = 23-24,000
Would you describe your telecare
  service as mainstreamed?



Yes = 20 (17)               (15)


 No = 2 (5)                (7)
                    Telehealth

• We don’t Know how many – counting them now

  But
            Carmarthenshire RCT = 240
• Main supplier of Telehealth packages in Wales say that
  through the Telecare Capital Grant they sold ....


                         86 !!
                   Community Alarms

They used :
POTS (plain old telephone system) systems
                                            Personal
                                            Contacts




  Existing
  Social
  Alarm
  Monitoring

                                            Emergency
                                            Services
                        Monitoring
                         Centre
                  Passive/Reactive Telecare

It is still :                                 Personal

POTS (plain old telephone system) systems     Contacts




Passive Sensors in the
home..




                              Monitoring
                               Centre



                                            Emergency
                                            Services
                            Alarms – A Reactive
                            Telecare System

                                                          Wireless alarm
                                                                                  Advanced
              Smart Sensors
                                                                                   Lifeline
                                                                                     Unit
                                      Duty Social
                                       Worker
            Out-of-hours Mobile Warden                 24 Hour
            GP
Relatives                                            --Nurse
& friends                                                         24 hour
                                                                  Gas
                                                                  fitter
                                                      Emergency
        Response Team
       Rapid
                                                      plumber

       Response
       Team
            Lifting
                                                          24 hr. Home Care
            service        Fire
                           service
                                                 Police
                                                                             Contact &
             Community
               Alarm
                                                                             Coordination centre
               Centre                Ambulance
Community Alarm Centre
                                    Separate Health & Social Care Systems
                                  Cholesterol
                   Blood-          Monitor
                  pressure
                    Cuff
                                                                                                           NHS Direct
               Scales

             Glucose
             Sensor                                      Telehealth Care Record
                Pulse
                Oximeter
                 Medication
        Elderly   Tracking
                                                                                            Healthcare Professionals
living independently
                                                 Home Hub
                                                 Appliance



                                                                                  Social Worker
                                                    Community Alarm
                                                        Centre
                                                                                               Emergency Services
      Home Automation
      Security Wireless Network
      • Lights
      • Doors windows
      • Motion / Activity
      • Bed
      • Drawers                                 Coordination                                Care Response Service,
                                                                                                  Warden etc
      • Kitchen
      • Bathroom
                                                  Required
                                                                         Family, friends and
                                                                            volunteers
   Contact & Coordination Centres
Potential Roles:
• Hospital Discharge
• Preventing Admission – co-ordinating services to support at home
• Real Time updating and communication of care plan
• Changing the care package – Responsive.

Telehealth:
• Installation, Maintenance, Administration
• Traffic Light System means clinical involvement only at last point of
   process

           • This is Mainstreaming Technology !!!
Integration of Services Cost-effectively
 County 1                                County 2
                    Home

                             Response
                             Response
    Coordination               Team 1         Coordination
     & Contact                                 & Contact
       centre                                    centre
    8am–6pm Mon                               8am–6pm Mon
        - Fri                                     - Fri
                             TELECARE
                            MONITORING    Response
   Response                                Team 2
    Team 4                    CENTRE
                                 24/7
                                              Coordination
  Coordination                                 & Contact
   & Contact       Clinic                        centre
     centre                                   8am–6pm Mon
  8am–6pm Mon                 Response            - Fri
      - Fri                   Team 3
 County 4                                   County 3
 Telehealth on a Telecare Platform
• We are ready
• Seize the moment with the LHBs & Regional
  partnerships
• The technology enables us to provide telehealth
  monitoring services and telecare alarm services
  alongside.

• We need to be proactive and not miss this
  opportunity to provide truly integrated services
         Cottage Industry Thinking
• How far away are we from turning ‘Community Alarm Services’ in to
  ‘Contact & Co-ordination Centres‘ which can co-ordinate the
  delivery of integrated health and social care services
• We are so far away that Care Line’ services are not being informed
  when service users are in care homes or hospital. Many have no
  idea where users are unless an alarm goes off
• Does all the required service user information go in to the service?
• Does all the call centre’s knowledge of service users’ needs &
  history inform how you can maintain people’s independence.
• Are the ‘Call Centres’ really full players in the delivery of health &
  social services
• Are they really part of the mainstream?
• Or are they are still a ‘one-trick-pony’ re-active service?
What We Know & What We Need

              Communication Hubs

3 Functions                   3 Contexts

Library Function              National
Call Handling                 Regional
Care Coordination             Local
     Framework of Services for Older
            People – 2011
• The focus of this ‘Framework of Services for Older People’
  will be upon how these public services work together to
  promote the independence of frail older people either in
  their own homes or in other homely settings. It will
  contribute to the achievement of modern, accessible and
  responsive services capable of meeting people’s needs and
  of being delivered flexibly, consistently and sustainably
  across organisational boundaries. In addition to enabling
  people to live as independently as possible, services must
  assist them to recover independence where this has been
  threatened, must promote and protect their dignity, must
  promote social inclusion, must support them at times of
  difficulty and protect them from harm.
Framework of Services for Older
       People – 2011



The word ‘Telecare’
appears 51 times
         Framework for Telecare
• Within the next few months the Welsh Government
  will be publishing updated guidance that will build
  upon lessons learned over the past five years and will
  continue to promote the strategic development of this
  service. The guidance will be directed towards
  ensuring that we make the best use of telecare and
  realise the benefits of closer integration with other
  services such as telehealth, community equipment,
  adaptations, etc. We also need to exploit the potential
  of the communications centre at the heart of telecare
  to provide more effective services.
  The Social Care Battleground
                 Question:
 What will prevail? -Short term survivalism or
           long term sustainability.
                  Answer:
 Organisations will need to work together in
  partnership and with innovation if we are
 going to meet the challenge to demonstrate
that preventative services are more efficient in
                 the long run
What We Know & What We Need


The Sustainability & Mainstreaming of Telecare
  depends upon the development of a national
   comprehensive care strategy that embeds
  telecare into health, housing and social care
                     services
 What We Know & What We Need

Pooled Health & Local Authority Budgets to

• Purchase telecare and telehealth equipment
• Integrated data collection & management
• Co-supervision of telecare and telehealth
What We Know & What We Need

National/Regional purchasing strategies with
 clear specifications to secure better products
                  from suppliers

A full-time professional in charge of Telecare /
 Telehealth regionally. With a level of authority
                    and skills
 What We Know & What We Need

   Better and more consistent training for users,
               referrers and assessors

             Fully dedicated assessors

Charging policies that remove perverse incentives –
          public/private funding strategy ?

              A Robust Business Case
Why is Telehealth Delivery so low ?
• This presentation has concentrated on the supply side
• And the received wisdom is that we need get clinical involvement
  (esp. GPs) to work through telehealth

• Why aren’t clinicians flocking to it?
• Is it because health care is still too Hospital based>

• But is there a nightmare scenario that service user (patient)
  demand is low ?? – have we measured it?

• Is it that telecare is still too ‘cottage industry’ to help?
• Is it that Health & Social care are still not able to work together?
• Or is it just the stage we are at?
    Telecare in Wales
             Lee Davis
        Welsh Government
            07808 727466
            029 2080 1410
      Lee.Davis@Wales.GSI.gov.uk


www.ssiacymru.org.uk/telecare

				
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posted:12/30/2012
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