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					Report



meeting        SUPPORTING PEOPLE COMMISSIONING BODY


date           14th April 2008                             agenda item number       9

REPORT OF THE SERVICE HEAD, STRATEGIC HOUSING & SUPPORTING
PEOPLE

SUPPORTING PEOPLE STRATEGIC REVIEW OF OLDER PEOPLE’S
SERVICES

1.     Purpose of the Report

1.1    The purpose of the report is to:

       (i)     update the meeting on the progress of the strategic review and
               next steps.

       (ii)    outline issues affecting investment decisions by current providers
               of telecare services.

       (iii)   inform the Commissioning Body of initiatives by Nottinghamshire
               local authorities to explore options for a Shared Services
               Approach to the future provision of telecare services.

       (iv)    map the potential impact of future telecare services in meeting
               the indicators in the new National Performance Framework for
               local authorities and the possibilities for adopting a joint
               commissioning approach through the Local Area Agreement.

2.     Information and Advice

       Strategic Review update

2.1    It was originally anticipated that the outcome of the consultants‟ work in
       relation to the strategic review would be reported to this meeting;
       however significant delays in the completion of the work mean that this
       report will now come to the June meeting. This will allow for both
       further work to be undertaken on the Vision statement for Supporting
       People Older People‟s services as well as to enable the consultants to
       complete their work which has been delayed by illness.


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2.2    It is proposed that, following this report, more detailed work is
      undertaken at district level to develop district commissioning plans, with
      these plans taking into account current provision and need but also the
      direction given in the new national housing strategy for older people –
      „Lifetime Homes, Lifetime Neighbourhoods‟.

2.3   Alongside the work above, significant progress has been made in
      relation to plans for telecare services, building on the existing
      community alarm network. This work is outlined below, with specific
      recommendations being made in relation to its future direction.

      Telecare and alarm services

2.4   The basic community alarm service offering a means for householders
      to raise a call to a 24 hour monitoring centre has existed in much the
      same format for about 30 years. However, in recent years this service
      has been combined with other technologies to offer a wider telecare
      solution which can help to support people to live independently in their
      own home. These solutions range from automated home hazard
      monitoring, through to more sophisticated devices which can
      automatically alert if a person with dementia leaves home
      inappropriately or a person is experiencing an epileptic seizure at night.

2.5   The deployment of these wider telecare solutions has been a major
      Government policy initiative in recent years, with the Department of
      Health setting targets to increase the number of older people with
      telecare by 160,000 by April 2008 and a target for 2010 that telecare
      should be available in the homes of all people who need it.

2.6   In Nottinghamshire there are currently around 20,000 telecare users, the
      majority of which are contracted through Supporting People. Basic
      telecare services have traditionally been provided to older tenants in
      rented sheltered housing, but Nottinghamshire‟s district and borough
      councils (or their ALMOs) also provide basic telecare services to around
      3,500 owner occupiers.

2.7   Use of the wider range of telecare sensors in Nottinghamshire has been
      supported through a £1.1million allocation from the Department Of
      Health‟s Preventative Technology Grant and this has led to date to
      around 500 telecare sensors being installed in the homes of older
      people, with an expectation that this will rise to around 2500 sensors by
      April 2009.

      Current Issues Affecting The Provision Of Telecare Services

2.8   BT is currently implementing a major upgrade to the UK telephone
      network infrastructure, the 21st Century Network Project (21CN), which
      will mean that some older hard wired and dispersed telecare equipment
      currently used in Nottinghamshire will cease to work properly. The cost
      of upgrading incompatible equipment could run to hundreds of

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      thousands of pounds for some large providers.        Providers are
      concerned that future tendering of telecare services by Supporting
      People may affect their ability to recover investment in upgrading
      equipment, because future income streams may be removed.

2.9   Some providers who have sub-contracts for monitoring services which
      have expired or are nearing expiry are also being informed by their
      monitoring provider that they need to significantly increase their charges
      for monitoring in order to cover increased costs. Again, the future
      tendering of telecare services by Supporting People means that
      providers have to consider relatively short term contract extensions for
      monitoring, which may not realise best value.

      Shared Services Approach

2.10 The current issues concerning 21CN investment, contracts for
     monitoring and the uncertainty caused by future tendering of telecare
     services by Supporting People were discussed at the last meeting of the
     countywide local authority Chief Executives Group. This meeting
     suggested that all local authorities, including Nottinghamshire County
     Council, should explore the possibility of adopting a Shared Services
     Approach to the future provision of telecare services in Nottinghamshire.
     Shared Services is one option identified in the Gershon Report for local
     authorities to make efficiency savings. A meeting of local authority
     commissioners is being held on the 9th April 2008 to consider this
     approach and the outcome will be reported to this meeting.

2.11 Shared services offer one option for achieving efficiencies both for local
     authorities and Supporting People, but the extent of efficiencies which
     can be achieved through this approach will be dependent on the exact
     model of shared services being proposed. Adoption of a shared
     services approach will also need to be considered in the context of the
     procurement options available to the Administering Authority under its
     financial regulations and legal obligations.

2.12 Any efficiencies which could be realised through Shared Services would
     also need to be subject to an appraisal by local authorities compared to
     other options for achieving best value. For example, there is strong
     evidence from the prices available through the NHS PaSA National
     Framework Agreement For Telecare Services (an EU procurement-
     compliant agreement) that savings of several hundred thousand pounds
     per annum could be realised from an open tender of telecare services,
     or by utilising the contracts for telecare services which are available
     through this National Framework agreement.

      Mapping Telecare Services To The National Performance Framework &
      LAA

2.13 The current strategic review of Supporting People‟s older persons‟
     services will make recommendations concerning the future provision of

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       telecare, but as part of the work in the Supporting People team on
       preparing for the new National Performance Framework, a mapping
       exercise has been undertaken of the contribution which an expanded
       range of telecare services could make to meeting the new Performance
       Framework for local authorities. The full mapping is attached as
       appendix one to this report.

2.14   The mapping exercise has highlighted that telecare services can
       contribute to a large number of the National Performance Framework
       indicators. The exercise has also shown that this contribution will be
       significantly enhanced if there is close integration with the strategic and
       commissioning work of other partners, including district local
       authorities, the Nottinghamshire Fire & Rescue Service, Adult Social
       Care & Health, Crime & Disorder Reduction Partnerships, Trading
       Standards and the Primary Care Trusts. Given this, it is suggested that
       commissioning telecare services through the structures of the Local
       Area Agreement (LAA) should be explored. Utilising the LAA would
       enable cross agency support to be secured and ensure that the
       maximum benefit from telecare services was realised in supporting
       vulnerable people to maintain independence in their own homes.

3.     Statutory and Policy Implications

3.1    This report has been compiled after consideration of implications in
       respect of finance, equal opportunities, personnel, crime and disorder
       and those using the service. Where such implications are material, they
       have been described in the text of the report. Attention is, however
       drawn to the following:

3.2    Personnel Implications

       Adoption of a shared services approach and an open tender of telecare
       services may have TUPE implications for existing telecare service staff.

3.3    Financial Implications

       More detailed work on this would be required once the outcome of the
       Strategic Review of Older Person‟s services is complete and the
       outcome of the Shared Services meeting on the 9th April is known.
       Evidence from pricing available through the National Framework
       Agreement for Telecare Services, suggests that there are opportunities
       to realise contract savings of up to £400k per annum compared to
       current Supporting People contracts for telecare services.

3.4    Equal Opportunities Implications

       The procurement of telecare services which deliver against the
       outcomes mapped in appendix one of this report will enable a range of
       disadvantaged groups to benefit from enhanced telecare services to
       support their independence.

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3.5   Implications For Service Users

      The changes will enable a number of vulnerable service user groups,
      particularly older people, to benefit from a wider range of telecare
      equipment to help them stay independent at home.

3.6   Crime and Disorder Implications

      Some service users will benefit from specific telecare equipment to
      prevent crime, for example monitored burglar alarms and bogus caller
      buttons. Telecare equipment can also help to reduce the fear of crime
      by providing reassurance that the property is being monitored and that
      help can be summoned from anywhere in the home.

3.7   Human Rights Act Implications

      The Supporting People programme is part of the Government‟s agenda
      for improving the quality of family and private life of service users by
      fairer access to, and effective delivery of, housing-related support
      services.

4.    RECOMMENDATIONS

4.1   It is recommended that:

      a) Progress in respect of the ongoing Strategic Review is noted

      b) The current issues affecting providers of telecare services and the
         proposal from the local authority Chief Executives Group to explore
         a shared services approach is noted

      c) The meeting endorses an approach to the LAA to seek cross
         agency support for commissioning an expanded range of telecare
         services which meet the objectives outlined in Appendix One

      d) A further report is submitted to this meeting regarding the outcome
         of discussions regarding the approach to commissioning community
         alarm and telecare equipment and related services.

5.    Background Papers Available for Inspection

5.1   None.


RUTH RIGBY
Service Head, Strategic Housing & Supporting People




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Appendix One: Telecare Mapping To National Performance Framework


                     New Performance Framework - National         Role Of Telecare               Key
Outcome       NI                                                                                              Funding      Outcome Measure
                     indicators                                                                  Partners

                                                                                                 Police,
                                                                  Provision of monitored
                                                                                                 Trading      SP, CDRPs,
                                                                  burglar alarm, bogus caller                              Reduction In Serious Violent
              NI15   Serious violent crime rate                                                  Standards,   Trading
                                                                  and panic alarm systems for                              Crime Per 1000 population.
                                                                                                 Supporting   Standards
                                                                  vulnerable people
                                                                                                 People
                                                                                                 Police,
                                                                  Provision of monitored                                   Reduction in number of serious
                                                                                                 Trading      SP, CDRPs,
                                                                  burglar alarm, bogus caller                              acquisitive crimes per 1,000
              NI16   Serious acquisitive crime rate                                              Standards,   Trading
                                                                  and panic alarm systems for                              population
                                                                                                 Supporting   Standards
                                                                  vulnerable people
                                                                                                 People
                                                                                                 Police,                   Reduction in the number of
                                                                  Provision of monitored
                                                                                                 Trading      SP, CDRPs,   Actual Bodily Harm (assault with
                                                                  burglar alarm, bogus caller
              NI20   Assault with injury crime rate                                              Standards,   Trading      injury) crimes per 1000 of the
                                                                  and panic alarm systems for
                                                                                                 Supporting   Standards    population.
                                                                  vulnerable people
Stronger &                                                                                       People
Safer                                                                                                                      Reduction in local concerns about
Communities                                                                                                                anti-social behaviour and crime
                                                                  Provision of monitored         Police,                   by the local council and
                     Dealing with local concerns about anti-
                                                                  burglar alarm, bogus caller    LAs,                      police
              NI21   social behaviour and crime by the local                                                  SP, CDRPs
                                                                  and panic alarm systems for    Supporting
                     council and police
                                                                  vulnerable people              People


                                                                  Provision of monitored         Police,
                     Satisfaction with the way the police and                                                              Improved satisfaction rates for
                                                                  burglar alarm, bogus caller    LAs,
              NI24   local council dealt with anti-social                                                     SP, CDRPs    the way police and LA deal with
                                                                  and panic alarm systems for    Supporting
                     behaviour                                                                                             anti-social behaviour
                                                                  vulnerable people              People
                                                                  Provision of monitored
                                                                                                 Police,                   Reduction in satisfaction gap
                     Satisfaction of different groups with the    burglar alarm
                                                                                                 LAs,                      between white and BME victims
              NI25   way the police and local council dealt       bogus caller and panic alarm                SP, CDRPs
                                                                                                 Supporting                of anti-social behaviour.
                     with anti-social behaviour                   systems for vulnerable
                                                                                                 People
                                                                  people



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                     New Performance Framework - National         Role Of Telecare                 Key
Outcome       NI                                                                                               Funding      Outcome Measure
                     indicators                                                                    Partners

Stronger &                                                        Provision of monitored panic                              Improved percentage of victims of
Safer                                                             alarm systems.                                            a serious sexual offence
                     Specialist support to victims of a serious                                    DV Leads,
Communities   NI26                                                                                             SP, CDRPs    receiving support.
                     sexual offence                                                                CDRP, SP

                                                                                                                            Percentage reduction in repeat
                                                                                                                            victimisation for those domestic
                                                                                                   DV Leads,                violence cases
                                                                  Provision of monitored panic                 SP, CDRP,
              NI32   Repeat incidents of domestic violence                                         Police,                  being managed by a Multi-
                                                                  alarm systems.                               Police
                                                                                                   CDRP, SP                 Agency Risk Assessment
                                                                                                                            Conference

                                                                                                                            Reduction in number of deliberate
                                                                  Provision of monitored           Fire &      SP, Fire &
                                                                                                                            primary fires and secondary
                                                                  smoke detection equipment        Rescue      Rescue
              NI33   Arson incidents                                                                                        deliberate fires per 10,000
                                                                  in homes of people               Service,    Service,
                                                                                                                            Population.
                                                                  assessed as high fire risk.      SP          ASCH
                                                                                                                            Reduction in number of domestic
                                                                                                   DV Leads,
                                                                  Provision of monitored panic                 SP, CDRP,    homicide offences per 1,000
              NI34   Domestic violence – murder                                                    Police,
                                                                  alarm systems                                Police       population.
                                                                                                   CDRP, SP
                                                                  Provision of monitored                                    Reduction in total number of
                                                                  smoke detection equipment                                 primary fires per 100,000
                                                                  in homes of people who                                    population.
                                                                  would not be able to respond     Fire &      SP, Fire &   Reduction in total number of
                     Number of primary fires and related
                                                                  appropriately to a stand         Rescue      Rescue       fatalities due to primary fires per
              NI49   fatalities and non-fatal casualties,
                                                                  alone smoke alarm (people        Service,    Service,     100,000 population.
                     excluding precautionary checks
                                                                  with physical, mental and        SP          ASCH         Reduction in total number of non-
                                                                  learning disabilities, people                             fatal casualties per
                                                                  with addiction problems, frail                            100,000 population.
                                                                  elderly).




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                         New Performance Framework - National           Role Of Telecare                  Key
Outcome          NI                                                                                                   Funding         Outcome Measure
                         indicators                                                                       Partners

                                                                        Provision of telecare
                                                                        promoting sense of well
                                                                        being. Telehealth offers                                      Awaiting definition from the new
                         Self-reported measure of people’s overall      opportunities for routine         PCTs, SP,   PCTs for        Place Survey, which is currently
                 NI119
                         health and wellbeing                           management of people with         ASCH        telehealth.     out for consultation.
                                                                        long term and chronic
                                                                        conditions to enable early
                                                                        diagnosis of problems.
                                                                                                                                      Improvement in directly age and
                                                                        Telecare will ensure timely       SP, ASCH,                   sex standardised mortality rate
                                                                        intervention which may            Fire &                      per 100,000 population,
                                                                                                                      SP, ASCH,
                 NI120   All-age all cause mortality rate               prevent death, e.g. fire, co2     Rescue                      from all causes at all ages
                                                                                                                      PCT
                                                                        poisoning, falls and inactivity   Service,                    (impact will be primarily for older
Adult Health &
                                                                        alerts.                           PCTs                        people)
Well-being
and Tackling
                                                                        Telecare can identify early
Exclusion
                                                                        deterioration in condition for                                Increase in percentage of people
& Promoting
                                                                        people with dementia and                                      with a long-term condition who
Equality
                         People with a long-term condition              other long term conditions,                   PCT             are “supported by people
                                                                                                          ASCH,
                 NI124   supported to be independent and in             through lifestyle and                         (Telehealth),   providing health and social care
                                                                                                          PCTs, SP
                         control of their condition                     inactivity monitoring.                        ASCH, SP        services to be independent and in
                                                                        Telehealth can provide                                        control of their condition”
                                                                        remote management of vital
                                                                        signs for people with LTCs.
                                                                                                                                      The proportion of older people
                                                                                                                                      discharged from hospital to their
                                                                        Provision of tailored telecare
                                                                                                                                      own home, who are still at home
                                                                        on hospital discharge to
                         Achieving independence for older people                                          PCTs,       PCTs,           three months after the
                 NI125                                                  ensure that people are safe
                         through rehabilitation/intermediate care                                         ASCH, SP    ASCH, SP        date of their discharge from
                                                                        at home, and have access to
                                                                                                                                      hospital.
                                                                        emergency support .




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                         New Performance Framework - National          Role Of Telecare                Key
Outcome          NI                                                                                               Funding      Outcome Measure
                         indicators                                                                    Partners

                                                                                                                               Improvement in the number of
                                                                                                                               people who self report that they
                                                                       Provision of all community
                                                                                                                               are Extremely or Very Satisfied
                                                                       care assessed telecare
                                                                                                                               with the help they receive from
                         Self reported experience of social care       (which will contribute to
                 NI127                                                                                 ASCH, SP   ASCH, SP     social services. (NB: This is
                         users                                         social care users‟
                                                                                                                               under review by the national
                                                                       experience of the help they
                                                                                                                               Strategic Information Group for
                                                                       receive).
                                                                                                                               Adult Social Care).

                                                                       Provision of telecare
                                                                       equipment to maintain                                   Work on the indicator is currently
                         User reported measure of respect and
                                                                       service user‟s dignity and      PCTs,      PCTs,        being undertaken by the
Adult Health &   NI128   dignity in their treatment
                                                                       modesty, e.g. automatic         ASCH, SP   ASCH, SP     Commission For Social Care
Well-being
                                                                       night-time enuresis                                     Inspection.
and Tackling
                                                                       detectors, epilepsy monitors.
Exclusion
                         End of life care – access to appropriate
& Promoting                                                            Telecare can provide dignity
                         care enabling people to be able to choose                                     ASCH,      ASCH, PCT,   Improvement in the percentage
Equality         NI129                                                 in end of life care, e.g.
                         to die at home                                                                PCT, SP    SP           of all deaths that occur at home.
                                                                       enuresis monitors.
                                                                                                                               Improvement in the percentage of
                                                                       Self Directed Support will be                           adults, older people and carers
                         Social Care clients receiving Self Directed
                                                                       a feature of the main SP                                receiving social care/housing
                 NI130   Support (Direct Payments and Individual                                       ASCH, SP   ASCH, SP
                                                                       programme as this is                                    related support through self
                         Budgets)
                                                                       implemented.                                            directed support per 100,000
                                                                                                                               population aged 18 or over.
                                                                                                                               Reduction in the rate of delayed
                                                                       Tailored telecare can                                   transfers of care from all NHS
                                                                                                       PCTs,      PCTS,
                 NI131   Delayed transfers of care from hospitals      support safe and timely                                 hospitals per 100,000
                                                                                                       ASCH, SP   ASCH, SP
                                                                       discharge from hospital.                                population aged 18+.

                                                                                                                               The proportion of telecare
                                                                                                                               equipment installed within 4
                                                                                                                               weeks of a social care
                         Timeliness of social care packages            Timely installation of
                 NI133                                                                                 ASCH, SP   ASCH, SP     assessment meets or exceeds
                                                                       telecare equipment.
                                                                                                                               the current performance target of
                                                                                                                               Nottinghamshire County Council.

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                         New Performance Framework - National           Role Of Telecare                Key
Outcome          NI                                                                                                 Funding       Outcome Measure
                         indicators                                                                     Partners

                                                                        Basic telecare monitoring at
                                                                                                                                  Reduction in the number of
                                                                        home of people with long        Health
                         The number of emergency bed days per                                                       Health, SP,   emergency bed days per head of
                 NI134                                                  term conditions, inactivity     partners,
                         head of weighted population                                                                ASCH          weighted population
                                                                        monitoring, telecare falls      ASCH, SP
                                                                        management solutions.
                                                                                                                                  Increase in proportion of carers
Adult Health &           Carers receiving needs assessment or                                                                     whose needs were assessed or
                                                                        Provision of telecare
Well-being       NI135   review and a specific carer’s service, or                                      ASCH, SP    ASCH, SP      reviewed by the council in a
                                                                        equipment to support carers
and Tackling             advice and information                                                                                   year who received a specific
Exclusion                                                                                                                         telecare carer‟s service.
& Promoting                                                                                                                       Increase in the number of adults
Equality                                                                                                                          aged 18-64/65+ per 1,000
                                                                        Provision of all telecare                                 population that are assisted
                         People supported to live independently
                 NI136                                                  equipment which helps           ASCH, SP    ASCH, SP      directly through social services
                         through social services (all ages)
                                                                        people to live independently.                             assessed or care planned,
                                                                                                                                  funded support to live
                                                                                                                                  independently.
                                                                                                                                  Increase in the number of people
                                                                                                        Health,     Health,       aged 65 who self-report healthy
                 NI137   Healthy life expectancy at age 65              Provision of all telecare.
                                                                                                        ASCH, SP    ASCH, SP      life expectancy, applied to life
                                                                                                                                  expectancy data.
                                                                                                                                  Improvement in self reported
                         Satisfaction of people over 65 with both       Provision of all telecare       SP, ASCH,   Health,
                 NI138                                                                                                            levels of satisfaction among
                         home and neighbourhood                         equipment                       Health      ASCH, SP
                                                                                                                                  people aged 65 and over.
                                                                                                                                  Improvement in the proportion of
                         People over 65 who say that they receive                                                                 people who report that they
                         the information, assistance and support                                                                  receive the information,
                                                                        Provision of all telecare       SP, ASCH,   SP, ASCH,
                 NI139   needed to exercise choice and control to                                                                 assistance and support needed to
                                                                        equipment.                      PCT         PCT
                         live independently                                                                                       exercise choice and control to live
                                                                                                                                  independently

                                                                        Needs based assessment                                    Included in Place Survey,
                 NI140   Fair treatment by local services                                               PSA 15      No
                                                                        for telecare.                                             currently subject to consultation.
                                                                                                                                  Higher number and proportion of
                         Number of vulnerable people who are            Provision of all telecare
                 NI142                                                                                  SP          SP            people who are helped to
                         supported to maintain independent living       equipment.
                                                                                                                                  maintain independent living.

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                         New Performance Framework - National           Role Of Telecare                 Key
Outcome          NI                                                                                                  Funding        Outcome Measure
                         indicators                                                                      Partners

                                                                        Provision of telecare to
                                                                        support adults with learning
                                                                                                                                    Increase in the percentage of
                         Adults with learning disabilities in settled   disabilities in settled          SP, ASCH,   SP, ASCH,
                 NI145                                                                                                              adults with learning disabilities in
                         accommodation                                  accommodation (e.g. home         Health      Health
                                                                                                                                    settled accommodation.
                                                                        hazard sensors, epilepsy
                                                                        sensors).
                                                                                                         SP,
                                                                        Monitoring centre linked                     SP, Children
                                                                                                         Children                   Increase in the percentage of
                                                                        telecare units so that care                  and Young
                 NI147   Care leavers in suitable accommodation                                          and Young                  care leavers in suitable
                                                                        leavers can access support                   People's
                                                                                                         People's                   accommodation.
                                                                        (particularly out of hours).                 Services
                                                                                                         Services
                                                                        Monitoring centre linked
                                                                        telecare units so that people
                                                                        can access support
                                                                                                                                    Increase in percentage of adults
                                                                        (particularly out of hours).
                         Adults in contact with secondary mental                                         SP, ASCH,   SP, ASCH,      in contact with secondary mental
                 NI149                                                  Telecare home hazard
                         health services in settled accommodation                                        PCT         PCT            health services in settled
                                                                        sensors for people who may
                                                                                                                                    accommodation.
                                                                        not respond appropriately to
                                                                        standalone fire, co2 detectors
                                                                        etc
                                                                        There is strong evidence
                                                                        that significant value for
                                                                                                                                    Increase in the total net value of
Local                    Value for money – total net value of           money savings could be
                                                                                                                                    ongoing cash-releasing value for
Economy and      NI179   ongoing cash-releasing value for money         realised by tendering            SP, LAs     -
                                                                                                                                    money gains that have been
Environmental            gains during financial year                    telecare services currently
                                                                                                                                    realised in the financial year.
Sustainability                                                          contracted by Supporting
                                                                        People.




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