DRAFT
Commissioning Strategy
for Telecare Services
2014/15 – 2017/18
Contents
Forward
2
Key messages
4
1) Introduction
5
2) Vision, aims and outcomes
8
3) Strategic context
10
4) Delivering the strategy
14
5) Conclusion
30
Appendix A – overview of Telecare devices
31
Appendix B – Telecare case study
33
Appendix C – older people population information
34
Appendix D – glossary of terms
36
DRAFT Lancashire Commissioning Strategy for Telecare Services 2014/15 –
2017/18 v1.2
Forward
Over the last year since I became Lancashire County Council's Cabinet Member for
Adult and Community Services, I have been impressed by the response of the social
care workforce, families and communities across the county to the tremendous
challenges that we are facing.
Some of these challenges are welcome – for example the public's demand for more
flexible services, greater personalisation and higher quality. We are also determined
to work closely with our partners and colleagues in the NHS to ensure a more
integrated service for the citizens of Lancashire.
Other challenges are much harder to feel positive about such as the severe funding
reductions that the County Council faces. Over £300,000,000 of budget savings has
to be found by the County Council by the end of March 2018. These reductions are
clearly placing huge pressures on social care services that in turn can be a source of
concern for many people who rely on such support to sustain their independence and
safety at home. Indeed such pressures also cause anxiety for their family and friends
who often assist by coordinating or providing care and support to them.
The County Council will of course continue to lobby Government to achieve an
improved financial settlement for Lancashire. We will aim to be even more efficient in
all that we do so that taxpayers' money goes as far as possible for delivering public
services. For many of our services we also have to pass on part or all of the costs to
those who use them – so we need to be sure we are securing the best possible price
and value for money.
This is the background I would ask you to bear in mind as you read and respond to
the consultation on this draft Telecare Strategy. We will have to provide much of our
social care very differently in future – more personalised, more efficient, more
affordable and more responsive to people's needs, aspirations and circumstances. I
am therefore particularly enthusiastic in approaches to social care which offer us a
way of achieving more than one of these outcomes at the same time.
I am confident that Telecare is part of the solution to these issues. For various reasons
we have not made as much progress as we would have liked in developing and
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DRAFT Lancashire Commissioning Strategy for Telecare Services 2014/15 –
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growing our Telecare service in the years since it was first set up in 2006. However I
believe this Telecare Strategy forms the basis for major change and improvement in
the service in Lancashire over the next 3 years or more.
This consultation period which runs until 15th September 2014 is your chance to
comment and improve this Telecare Strategy. We have already had discussions with
many organisations and individuals about what we want our Telecare service to
achieve and we have received information and advice from many of them about how
we can increase our chances of success. Much of this learning is already incorporated
in this document.
Now it's your turn…….so please take the time to read this document for yourself and
let us know how you think we can make Telecare work successfully in Lancashire.
(Insert signature)
Tony Martin
Cabinet Member for Adult and Community Services
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DRAFT Lancashire Commissioning Strategy for Telecare Services 2014/15 –
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Key messages

Improving Outcomes… The use of assistive technology, such as
Telecare, has a significant role in helping people to maintain their
independence and stay safe.

Making Cash Savings… Telecare must significantly contribute to
the delivery of financial savings by reducing the demand for more
costly and intensive services across the Lancashire health and
social care economy.

Growing the Service… The intention in re-commissioning the
Telecare service is to achieve sustained growth, with the ambition
of having 7,000 people receiving Telecare by the end of 2017/18.

Maximising the benefits… To reach individuals who will benefit
most from Telecare, access arrangements, eligibility criteria and the
charging policy will be reviewed and changed to support our
intentions, with those individuals who are eligible receiving Telecare
free of charge.

Developing the workforce… Ambitious Learning and
Development goals will be set to ensure across the health and social
care workforce there is a sound understanding of the purpose and
benefits of Telecare.

Delivering in Partnership… Statutory, voluntary, private and
community organisations must play a leadership role with the
County Council to support the growth of the service, and to ensure
Telecare is embedded within locality based care services.

Evaluating the impact… External research bodies and our own
business intelligence services will be commissioned to ensure there
is robust evaluation of the Telecare Service.
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DRAFT Lancashire Commissioning Strategy for Telecare Services 2014/15 –
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1) Introduction
1.1 Background
It is well known that the health and social care system is facing enormous challenges,
as people are living longer often with more complex care needs and health conditions.
So we must find new approaches that enable more efficient and effective care, and
support people to live independently with better outcomes.
Within this context, health and social care commissioners within Lancashire are
increasingly focussing on ways of helping people to better look after their own health
and wellbeing, and developing service delivery models that enable more people to be
supported at home or in their local community.
We recognise that effective assistive technology services, such as Telecare, can play
an important role in helping to achieve this. Therefore, we are committed to improving
and expanding the use of Telecare, so it becomes an integral part of our adult social
care offer and is embedded within the wider changes being made by us and our NHS
partners.
This strategy sets out the major developments that will need to take place by the end
of March 2018, in order to achieve our vision for an effective Telecare service in
Lancashire.
1.2 What is Telecare?
Telecare is a service that enables people, especially older and more vulnerable
individuals, to live independently and securely in their own home. It includes services
that incorporate personal and environmental sensors in the home, and remotely, that
enable people to remain safe and independent in their own home for longer. 24 hour
monitoring ensures that should an event occur, the information is acted upon
immediately and the most appropriate response put in train1.
Telecare devices include pendant alarms, falls detectors, medication dispensers,
movement detectors, smoke detectors, carbon monoxide detectors, enuresis sensors,
1
Definition from 3millionlives: http://3millionlives.co.uk/about-telehealth-and-Telecare
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epilepsy sensors, extreme temperature sensors to name a few – an overview of
Telecare devices is shown at Appendix A. There are a range of other devices that
help support people in their community, such as GPS monitoring systems for people
with a learning disability or dementia.
There are four key stages of how Telecare works:
It is worth highlighting that Telecare is more than just about the devices or the
technology itself. The right people and organisations providing the range of services
– including assessment for Telecare, installation of the devices, monitoring of alerts
and providing a suitable response – are a vital part of an effective Telecare service.
1.3 Current Service
Compared to many other councils in the UK, the number of people using Telecare in
Lancashire is relatively low. As of June 2014, we have just 1,100 Telecare service
users, a low volume of new referrals and the full potential of Telecare is not being
reached.
There are a range of reasons for this but the main barriers are:

The service model is fragmented and has not sufficiently supported the
expansion of Telecare.

Staff generally find the referral process to be overly complicated, confusing and
inconsistent.

Telecare is not embedded into our assessment and support planning activities,
so it is often just bolted-on to other services or is not considered as a potential
support option at all.

The charging arrangements and the financial assessment process can act as
a deterrent to potential users.

Staff have not been provided with enough learning opportunities to improve
their skills and awareness.
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Also, the current access and assessment arrangements mean that people who could
benefit from just a Telecare service have to go through a full social care assessment
and it will only be supplied if the person is assessed as having 'substantial' or 'critical'
needs under Fair Access to Care Services (FACS). This is a more expensive and
complex process than is necessary and it deters some agencies and individuals from
making Telecare referrals, or it can create unnecessary duplication of assessment.
Before we start to transform the service and implement our strategy, we are taking
steps to make some initial improvements, including closer working with our current
service providers, working with the Telecare Services Association (TSA) to train a
proportion of assessment and support planning staff, and we have reduced the
maximum charge to service users by almost half.
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2) Vision, aims and outcomes
2.1 Vision
The following vision statement summarises what we wish to achieve through the
delivery of this strategy:
To ensure more people benefit from the use of Telecare, so they increase or
maintain their independence, stay safe and continue living at home.
2.2 Aims
We have five key aims that will be central to how we take forward this strategy, which
are:
1. Ensuring Cost Effectiveness… To develop an affordable and effective
service that enables substantial growth in the number of people using the
service. This means ensuring ready access to Telecare for those who will
benefit most from the service.
2. Integrating services around the individual… To integrate Telecare within the
mainstream assessment, support planning and review processes for adult
social care and reablement services, in order to maximise people's ability to
continue to live independently with the minimum level of support to safely meet
their needs.
3. Working in Partnership… To work with our partners to ensure that Telecare
is widely understood and accessible to service users, carers, housing, health,
emergency services and social care professionals. Specifically with our NHS
partners to embed Telecare within integrated locality based services, so people
get the right care, in the right place at the right time.
4. Quality assured and ethically based… To develop a high quality and ethically
based Telecare service that strikes a reasonable balance between the
individual's right to autonomy, choice and control and wider strategic priorities
to achieve better outcomes and financial savings.
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5. Providing Leadership… To commission a Telecare service where the service
provider(s) play a major leadership role in driving the changes essential to
achieving the council's strategic aims.
2.3 Outcomes
Telecare can sustain people with a wide range of conditions in their own homes, and
offer support to their carers, so that resources which would otherwise be spent on
hospital, residential or nursing care can be allocated elsewhere in the health and social
care system2.
More specifically, an effective Telecare service can help vulnerable people achieve
these outcomes:

Enable better self-care

Enable them to stay in their own homes

Increase their choice and independence

Improve their quality of life

Reduce risk and make them feel safer

Provide carers with support and peace of mind

Promote early intervention and prevent a crisis

Prevent admissions to hospital

Enable timely and safe discharge from hospital.
The case study shown at Appendix A is based on one of our existing Telecare users
and describes how Telecare helped to deliver better outcomes and prevented her from
being admitted to residential care.
2
Care Services Efficiency Delivery (2009). Implementing Telecare to achieve efficiencies. Available at
http://www.thinklocalactpersonal.org.uk/_library/Resources/Personalisation/Personalisation_advice/Implementing
_Telecare_to_achieve_efficiencies.pdf
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3) Strategic context
3.1 Case for Development
The scale of the changes to our population that will take place over the next ten to
fifteen years will put huge strain on health and social care services financially and also
in terms of the workforce and informal carer support availability.
The Care Quality Commission's State of Care Report (February 2010) summed up the
effect these changes will have on our future as follows:
'Public finances are tightening and the Government expects that in 20 years time,
1.7million more adults in England will have a care and support need.'
Appendix B shows the scale of the predicted population growth in Lancashire,
including rates for people with dementia, suffering falls, living alone and with a severe
disability.
In summary, using 2011 as a baseline and forecasting through to 2020, there is
expected to be:

an increase of 22% in the over 65's population;

an increase of 33% in the over 85's; and

an increase of 48% in the over 90's.
In terms of dementia, it is forecast that by 2020 there will be an increase of 28% in the
incidence of dementia, with numbers rising to some 18,885. The numbers living alone
who are aged 75 and over will rise by 25% with similar percentage increases for those
people aged 65 and over relating to those experiencing a fall and those with a limiting
long term illness.
In response to the extremely challenging picture facing the health and social care
system nationally, there is wide support for much greater use of Telecare and other
assistive technologies. The current health and social care system response, which
relies mainly on providing 'more of the same', through services which are heavily
dependent on paid care staff, is already proving unaffordable. The further increased
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efficiencies and cash savings expected from both Councils and the NHS means urgent
changes are needed about whole system redesign.
It is important the council makes a commitment to expanding its Telecare service, as
it can enable a way of supporting individuals to live independently in their own homes,
which could also assist with the management of the financial pressures.
3.2 National policy
Successive governments have made clear their commitment to promoting
independence for older and vulnerable people and supporting them in their own
homes. Included in this is the expectation that assistive technology will be expanded
as part of the wider changes to improve prevention, raise service quality and extend
personalised care. Some of the key documents are summarised below:
Independence, Wellbeing and Choice: Our vision for the future
social care for adults in England (March 2005) – 'Telecare has
huge potential to support individuals to live at home, and to
complement traditional care.'
White Paper: Our Health, Our Care, Our Say: a new direction for
community services (Jan 2006) – 'Many local authorities in this
country have already shown that assistive technology can help people
retain their independence and improve their quality of life.'
Putting People First (2007) – 'Person centred planning and selfdirected support are to become mainstream and define individually
tailored support packages. Telecare is to be viewed as integral not
marginal.'
A Vision for Adult Social Care: Capable Communities and Active
Citizens (2010) – 'Telecare enables people to live at home
independently for longer by providing technologies that make their
homes more safe and secure.'
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A concordat between the Department of Health and the telehealth
and Telecare industry (2012) – 'The aim of 3millionlives is to
enhance the lives of three million people over the next 5 years by
accelerating the roll-out of telehealth and Telecare in the NHS and
social care.'
The Operating Framework for the NHS in England 2012/13 –
'Telehealth and Telecare offer opportunities for delivering care
differently but also more efficiently.'
We will also consider the implications of the new Care Act 2014 as we develop our
approach to Telecare, particularly in terms of access, eligibility and charging. We will
review the recently published draft regulations and guidance.
3.3 Local policy
The development of this strategy has also been put together within the context of local
policy drivers.
The council's Adult Social Care Commissioning Intentions 2012 – 2015 says we will:

'Offer an affordable and effective Telecare service and significantly expand the
existing service.'

'Utilise Telecare and other assistive technology to make it safer for people with
dementia to maintain their independence.'

'Develop a specific Telecare service for supported living schemes particularly
for people with a learning disability.' 3
The Better Care Fund Plan for Lancashire sets out how existing NHS and social care
funding will be jointly invested, so we can work together to improve outcomes for
people. It includes local plans on how we will act earlier, as part of a prevention and
early intervention approach, so that people can stay healthy and independent at home.
LCC Adult Social Care Commissioning Intentions 2012 – 2015 available at:
http://council.lancashire.gov.uk/documents/s13450/Appendix%20A.pdf
3
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The development and expansion of Telecare is included in Lancashire's Better Care
Fund Plan.
An effective Telecare service will also contribute to the delivery of Lancashire's
emerging Health and Wellbeing Strategy, particularly towards these elements:

'Shift resources towards interventions that prevent ill health and reduce demand
for hospital and residential services.'

'Promote and support greater individual self-care and responsibility for health;
making better use of information technology and advice.'

'Commit to delivering accessible services within communities; improving the
experience of moving between primary, hospital and social care.' 4
4
Lancashire Health and Wellbeing Strategy available at:
http://www.lancashire.gov.uk/corporate/health/index.asp?siteid=6715&pageid=40274&e=e
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4) Delivering the strategy
4.1 Procurement
The range of Telecare services that need to be procured are as follows:
Assessment
Marketing
and
promotion
Equipment
Workforce
development
Installation
Telecare
Service
Home
response
Repair and
maintenance
Equipment
removal and
reuse
Call centre
monitoring
There are many different forms of contracting Telecare services ranging from public
to private (or public/private partnerships), single organisations to consortia. These
requirements could be met by a single organisation or, alternatively, responsibilities
could be spread among a number of organisations, either via a set of subcontracting
arrangements or through a formal consortium. 5
5
Taken from 3millionlives Recommendations from Industry on Key requirements for Building Scalable
Managed Services involving Telehealth, Telecare, & Telecoaching. Available at:
http://3millionlives.co.uk/wp-content/uploads/2012/11/3millionlives-Industry-Recommendations-forScalable-Services.pdf
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Therefore, we have a number of options on procuring these services in terms of the
procurement model and also the route we take to get suitable bids from the market.
They are important decisions, as they will ultimately play a crucial role in the
effectiveness of the service and delivery of this strategy.
To help develop our understanding and approach to procurement, we have engaged
with Telecare providers, met with other councils that have successfully implemented
Telecare, held discussions with industry experts, considered a range of publications
and attended specific Telecare conferences and events.
We have now produced a Procurement Strategy that includes an options appraisal
against a range of key outcomes and sets out the two key decisions that have been
made to enable us to progress to the procurement stage. These are summarised in
the following table:
Outcome
a) To use an 'Open Tendering' procedure. This is a one stage
procurement process and is open to all qualified and interested
organisations.
OR
b) To use a 'Restricted Tender' procedure. The Restricted
Procedure is a two-stage process which allows the Council to
draw up a short-list of interested parties by undertaking a prequalification stage, prior to the issue of invitation to tender
1) Procurement
documents.
route
OR
c) To use a 'Competitive Dialogue' procedure. This allows scope for
dialogue with service providers within the procurement process
to develop suitable solutions to meet our requirements.
The one route we have specifically ruled out is the use of one of the
current Government, Housing or Technology sector Procurement
Frameworks that exist.
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To procure a 'Development Partner' that will:
 Lead and drive the strategic development and expansion of
Telecare e.g. workforce development, marketing and promotion,
developing partnerships and improving processes and systems.
2) Procurement
model
 Suitably package and subcontract the range of services to
organisations that are experienced and capable of providing high
quality and cost effective services.
 Manage the whole system effectively by coordinating and
bonding the services together so the end-to-end system functions
seamlessly as one for the end user.
With the exception of the home response service, all the above services will form part
of one procurement and contract.
For the home response service itself, we still need to develop our approach, but it is
expected we will contract separately with a number of home care providers under our
new home care framework agreement that will start to be implemented from early
2015. The reasons for this are we are best placed to commission this type of service
directly as this is part of our core business, it will help avoid duplication of existing
services such as crisis support, and the providers will be registered with the Care
Quality Commission so they may provide a more enhanced level of support when it is
required than is currently the case.
4.2 Related services in or out of scope
Service
In Scope?
Overview
Funded
under
the
Supporting
People
budget,
community alarms are devices typically provided in
specialist accommodation for older people (e.g.
Community
Alarms

sheltered or extra care housing), which requires
individuals to self-activate alerts either via a pendant or
pull cord alarms. There are approximately 17,000 in
Lancashire with about 5,000 self-funders.
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These alerts go to a call centre run or contracted by the
housing provider, and any home response required is
usually part of the sheltered or extra care housing
scheme manager's responsibility to establish and
mobilise in particular cases.
Technology used for providing door entry systems, fire
safety and community alarms are often integrated
systems owned by the landlords.
Whilst Telecare and community alarms currently
operate as completely separate services, there is a
significant degree of cross over in terms of the
infrastructure and target user groups for the two
services, although they do have distinctive histories
and features.
Therefore, during the lifetime of this strategy, and as
part of a potential later stage development, we will
explore, in conjunction with landlords, the most
appropriate relationship between community alarms,
delivered within a sheltered housing setting, and
Telecare.
This will take into account the above
technical issues and the approach to funding sheltered
housing.
However, Community Alarms should not be part of this
initial procurement exercise
Telehealth is a separate type of assistive technology
used by clinicians in the NHS to remotely monitor the
Telehealth
x
signs and symptoms of people with long term
conditions, such as heart failure, stroke, diabetes and
chronic obstructive pulmonary disease.
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There are small pockets of telehealth activity locally
within the NHS, but it is not well established currently
and there are no firm plans about what role telehealth
may play in the future.
Therefore, it is not possible for Telecare and telehealth
to be jointly commissioned with our NHS partners at
this time.
Our Peace of Mind 4 Carers service provides an
emergency backup service for unpaid family carers.
The service has three main elements:
1. Carers services develop contingency plans with
the carer and the person they care for
2. A number of home care providers that can be
called upon to provide up to 72 hours of free
replacement care
3. A call centre function offering a 24/7 dedicated
Peace of
Mind 4
Carers

telephone line.
The core functions of the 24/7 call centre include:
 Taking emergency calls, making a decision about
whether the situation is an emergency and
arranging the appropriate care
 Ensuring care has arrived within the one hour
deadline and that the person providing the
replacement care has the information they require
to care effectively
 Sending out newly registered plans to carers and
making amendments to existing plans as required.
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The 24/7 call centre will be part of the Telecare
procurement, as the service will be provided by the
Telecare monitoring centre(s).
4.3 Telecare service model
The proposed model for our new Telecare service is illustrated below setting out the
key stages followed by an overview description of each stage:
1) Referral
2) Home
assessment
7) Review
6) Repair
and
Maintenance
3)
Installation
4)
Monitoring
5) Response
1. Referrals will normally be received following an appropriate level of assessment
by a health or social care professional and where it is identified Telecare will help
meet a person's needs. Also, we will explore the possibility of direct referrals from
other partner organisations and the feasibility of introducing self-assessment. The
referral processes and systems that support it will be user friendly and people will
be clear on what they need to do, so they are not discouraged from making
referrals.
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2. Home assessments will be carried out to understand what Telecare equipment
the service user needs and confirm they have consented to it. The service user
and their carer will be fully involved in deciding what equipment will help support
them. The assessment will be person centred so that decisions, including the type
of equipment, is based on their individual needs and acceptability.
3. Installation of equipment will be based on the outcome of the personalised home
assessment. We expect there to be a standard equipment catalogue to be used
in the majority of cases, but also there to be flexibility to provide other products on
the occasions where alternatives have been assessed as needed.
That will
include both standard Telecare equipment used in a person's home and also,
where appropriate, equipment that may support people to live well in their
community e.g. GPS monitoring technology. The equipment available will be
updated as the technology develops and, like many other goods, as it becomes
cheaper over time. The service user and their carer will be provided with training,
user guides and follow-up advice as required.
4. Monitoring will be undertaken by trained staff in a monitoring centre(s) responding
rapidly to calls and alerts raised through the Telecare equipment.
It will be
available 24 hours a day, 7 days a week, 364/5 days of the year. The staff will be
well trained to support vulnerable people and be able to develop knowledge of a
person's needs and other local services that may help support them.
5. Response to alerts by the monitoring centre(s) will be appropriate to the presenting
circumstances. In most cases, the monitoring centre will be able to deal with an
alert by talking to and reassuring the person, or they may need to contact the
user's family or friends. Sometimes a 24/7 home response service will be needed,
or referrals to other community based health and social care services. In a small
proportion of cases emergency services may need to be contacted.
This means there will be a staged or stepped approach to how responses are
managed by the monitoring centre, to ensure that the level of response is tailored
to the needs of the service user:
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Tiers of Response
5) 999
4) Community based
health and social care
3) Home response service
2) Family or friends respond and visit
1) Monitoring centre with no physical response needed
As stated previously, we still need to develop our approach to the home response
service. It is likely we will use it in a targeted way and primarily when it is needed
to respond to social care emergencies, or where it will prevent the need for more
intensive social or health care services. The home response service will almost
certainly not be a blanket offer because it would rapidly become unaffordable.
Where available, service users will be required to have named responders, such
as family and friends, so if they require a physical response, their own social
networks will be used when it is appropriate to do so.
6. Repair and maintenance services will be available and will include both regular
remote and onsite testing of all Telecare equipment supplied to each service user.
The standard service will operate during weekdays, but there will be an emergency
repair service that is able to respond to critical equipment faults within 24 hours.
7. Reviews will be undertaken by the provider(s) to monitor patterns of use, so that
changes in an individual's needs may be identified and acted upon. Where
appropriate, the service user, with their consent, may benefit from being referred
to other universal services to help meet their support needs e.g. befriending, or
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they may need a reassessment by a health or social care professional. This part
of the process will also assess outcomes and report on cost benefits.
4.4 Reaching the people who will most benefit
Experience both local and nationally shows that Telecare can help support a range of
people in specific situations. It is important we target the right people so that those
who will benefit from Telecare most are able to do so. This will also ensure that funding
is directed in the most appropriate way and financial benefits can be maximised.
We will promote and encourage the take up of Telecare by the following groups:

People who are frail

People with dementia

People who fall or who are at risk of falling

People with learning disabilities

People with physical or sensory disabilities

People with informal carers who need extra support.
We will focus particularly on people living in the following settings:

People living at home, especially those living alone

People coming out of hospital

People living in extra care, sheltered housing or support living schemes

People receiving reablement and other intermediate care.
These people will be identified in a variety of ways, including through effective
partnership working, marketing and promotion, Telecare being a part of other care
pathways and using case finding/risk stratification with our NHS partners.
4.5 Eligibility
As indicated previously, we currently fund Telecare to people who have been
assessed as having 'substantial' or 'critical' needs under FACS. We want to widen our
offer, but we will only be able to do that once the procurement has been completed
and the new service implemented, which is expected to be in spring 2015. This is
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because the cost of the current service is too high, so growing the service significantly
beforehand would not be affordable.
At that point, we will introduce new eligibility criteria that will support our growth plans
and complement the target groups we aim to reach. To make our intentions on
eligibility clear it is helpful to summarise it into three approaches:
1) FACS eligibility
approach
• We will continue to
fund Telecare to
people with
'substantial' or 'critical'
needs under FACS.
• We will mainstream
Telecare so it is an
integral part of social
care assessment and
support planning.
• We will make Telecare
a key part of our initial
offer of social care
support.
• We will fund Telecare
outside of personal
budgets so any other
support can be
planned around it.
2) Reablement
approach
3) Preventative
approach
• We will offer Telecare
to people at the start of
reablement before
FACS eligibility is
confirmed.
• We will make sure
Telecare is considered
in each reablement
support plan.
• We will make sure
those eligible for
ongoing care have
their support planned
around Telecare.
• We will continue to
fund Telecare to those
not eligible for ongoing
care as part of the
preventative approach.
• We will trial Telecare
for up to 2,000 people
at risk of losing their
independence outside
of FACS.
• We will develop
separate criteria linked
to the groups we think
will benefit most from
Telecare.
• We will allow direct
referrals from other
agencies and explore
self-assessment.
• We will evaluate the
trial to decide whether
to extend it, change
the funding
arrangements or end
this type of offer.
There may be a proportion of our local population not eligible for Telecare funded by
the Council, but who wish to receive it and pay for it themselves. We will aim, through
our procurement, to work with a service provider(s) that will develop an effective selffunding route, which enables people to benefit from the council's buying power with
pricing levels broadly in line with what the council will pay.
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4.6 Charging
We have been told many times that one of the key factors preventing us from
increasing Telecare take up in Lancashire has been the deterrent effect created by
the imposition of charges to potential service users.
Therefore, upon introduction of the new service expected in spring 2015, we intend to
change the policy so that Telecare becomes a non-chargeable or free service to those
people who are eligible.
This means that people eligible for the service will not have to be financially assessed
specifically for Telecare and will not have to pay towards it – access will be based
purely on assessed need.
This will also apply to up to 2,000 people eligible for Telecare under our preventative
offer for the duration of the trial.
4.7 Performance
We want to be ambitious about how we grow the service and deliver at large scale
without us being tied in to reaching a specific volume contractually, so we have the
flexibility to adjust our plans as required.
We currently have about 1,100 people who have Telecare systems installed and by
the end of 2017/18 we will aim to expand the service to approximately 7,000 service
users. This level of increase is based on benchmarking with and learning from some
other councils. All aspects of this strategy have been designed to support this level of
growth.
As illustrated below, we estimate there to be some modest growth by the end of the
2014/15, as a result of some initial service improvements, that growth will increase in
2015/16, as the new service is introduced, and there to be further acceleration in the
following two years as the new service becomes established.
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4.8 Finance
The estimated annual cost of the size of our current Telecare service of 1,100 service
users is £557,000. Once we have introduced the new service, this level of funding will
support many more Telecare users, as the procurement will enable us to achieve
much better value for money through competitive pricing.
However, this level of investment will not be enough to grow the service to our intended
scale, so we have ring-fenced up to a maximum of £2.8m from our 'Prevention and
Early Intervention Reserve' to fund the transitional costs of the development and
expansion of the service during the period of this strategy on an 'invest to save' basis.
Once the service has been fully established we expect it to deliver net savings of
between £900,000 and £2.9m a year, which is based on two scenarios of reducing
home care and residential care expenditure.
As part of our procurement, we will explore the feasibility of entering into financial risk
sharing arrangements with the aim of a proportion of savings being underwritten and
guaranteed to us by the service provider(s).
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4.9 Workforce development
It is crucial we focus on the development of all staff involved in Telecare, so they have
the necessary skills, knowledge and confidence to support the implementation of our
strategy. The importance of this is well summarised in a research report produced by
Skills for Care6:
'It is clear that the quality of any service is driven by the knowledge, skills and
behaviour of the workforce that deliver it. Therefore without an improvement in these
areas, workforce development will continue to be so fragmented and variable that
assistive technology, telecare and telehealth will continue to underachieve in reaching
its full potential in sustaining and improving people's quality of life.'
As part of the development of our new service, we will ensure the right people are well
trained.
This will apply to our own staff, relevant people working for our key
stakeholders and those involved in providing the service.
There will be different levels of training according to the needs of the various groups,
ranging from short awareness to more in-depth training, using a variety of methods
from e-Learning modules to face-to-face instructor led training courses.
We will see this as a rolling programme because we recognise the need to update
skills as part of continuing professional development and be relentless in our approach
to developing a culture that embraces the use of assistive technology.
A detailed learning and development plan will be co-produced and the Learning and
Development Framework for Assisted Living Technology and Services 7 and Resource
Hub8 produced by Skills for Care may be used to guide us, as they are excellent
resources for workforce development.
6
Skills for Care, Workforce Development for Assistive Technology, Telecare and Telehealth: what is
the current landscape?, (2011). Available at: http://www.skillsforcare.org.uk/Document-library/NMDSSC,-workforce-intelligence-and-innovation/Research/Research-Reports/ALT/AT-Research-FeedbackNov-11.pdf
7 Available at: http://www.skillsforcare.org.uk/Document-library/Skills/Assisted-LivingTechnology/LDframework-introwithapps(v2).pdf
8 Available at: http://skills4carehub.virtual-college.co.uk/
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4.10 Service standards
As well as defining our own local quality standards, we will develop our understanding
about other standards to promote the provision of high quality services, which will form
part of our new service specification and contract.
To do this, we will engage the Telecare Services Association (TSA), which is the
industry body for Telecare and Telehealth, along with some organisations within the
market to develop the standards that will to govern our service.
The Telecare & Telehealth Integrated Code of Practice9 produced by the TSA is a
national quality framework and we may expect our service provider(s) to be or become
compliant with those standards.
We will also consider the appropriateness of other standards that may be meaningful
and relevant to the service, for example any applicable ISO international standards,
and explore the use of a suitable ethical framework.
4.11 Communications and marketing
We will work closely with our service provider(s) to develop a comprehensive
communications and marketing plan. This will be key to promoting the use of Telecare
and explaining the benefits of the service and how to access it. Our stakeholders,
including our own staff, our partners and the general public, will need to be engaged.
We will have to think carefully how about our approach and learn from what has
worked well and not so well in other places.
The plan may include these methods:
9

Printed and web based information e.g. factsheets, newsletters, case studies

Demonstrations and roadshows to individuals and groups

Developing a network of Telecare advisors within teams

Developing a Telecare users and carers group

Staff engagement and training

Use of local media e.g. local press
http://www.Telecare.org.uk/standards/Telecare-code-of-practice
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
Publicity in community settings e.g. GP surgeries, libraries

Developing a suitable friendly branding for the service.
4.12 Partnerships
Across England, the development and implementation of Telecare is often driven by
councils responsible for adult social care. Here in Lancashire we recognise the
importance of partnership working and consider effective collaboration to be a part of
implementing our Telecare strategy.
Our initial priority will be to fully establish Telecare within our adult social care offer,
but then we will increasingly work with our partners including:

NHS clinical commissioning groups

NHS trusts

Lancashire Fire and Rescue Service

North West Ambulance Service

District and Borough Councils

Social care providers

Support planning organisations

Housing providers

Voluntary, community and faith sector

Carers organisations.
Our partners can play a role in developing Telecare, identifying individuals who would
benefit from it and making appropriate referrals.
Some will need to be much more
involved than others, and our NHS partners in particular will need to help embed
Telecare into other care pathways and neighbourhood care teams, and support the
ongoing evaluation of Telecare.
4.13 Ethics
There are a number of important ethical issues associated with Telecare services,
particularly in relation to people with a cognitive impairment such as dementia. For
example if Telecare is deployed without regard to a person's human rights and dignity
it has the potential to impact on people's privacy, autonomy and control. It is important
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these ethical concerns are considered and taken into account when we design our
new service.
To assist us we will use the Ethical Frameworks for Telecare
Technologies for older people living at home10 produced by Lancaster University and
Ethical issues in the use of Telecare11 produced by Social Care Institute for
Excellence.
4.14 Developing a local evidence base
There are many examples of other councils that have published positive research
reports and case studies, and regard Telecare as a successful and proven intervention
which improves the quality of life for individuals and prevents or delays the use of more
intensive or costly services. However, other research, such as the Department of
Health sponsored Whole System Demonstrator programme, has indicated that
Telecare may not significantly reduce health or social care use or save money.
Therefore, it is best to describe the evidence base for the use of Telecare as
inconclusive, so it is vital we closely monitor and evaluate the impact locally going
forward. This will inform future service delivery and enable us to reconfigure our
approach if required based on our own robust evidence base.
We are already taking some positive steps forward – we are involved in the ATTILA
trial: assistive technology and Telecare to maintain independent at home for people
with dementia12 and we are working in partnership with Lancaster University on a three
year PhD studentship and evaluation study of our new service funded by the Economic
and Social Research Council. We will also work with our service provider(s) to design
an evaluation framework that will include measuring outcomes and return on
investment.
10
Available at: http://www.lancaster.ac.uk/efortt/
Available at: http://www.scie.org.uk/publications/reports/report30.pdf
12 More information at: http://www.controlled-trials.com/ISRCTN86537017
11
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5) Conclusion
We must do all we can to work with stakeholders to develop services that promote
independence, are appropriate to the needs of individuals, provide better outcomes
and enable a more efficient and effective integrated care system.
We must make sure that a high quality and expanded Telecare service becomes an
integral part of our adult social care offer and a key component of the range of
prevention and early intervention services that will be available across health and
social care.
This strategy has been designed with these principles in mind and in a way that will
best meet our vision and strategic aims for Telecare in Lancashire. It covers several
subjects but they should all be considered of equal importance and priority, as they
are interdependent and all elements must be properly addressed to enable the
successful implementation of the overall strategy.
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Appendix A – overview of Telecare devices
Base Unit: links to
the monitoring
centre by phone line
when activated by a
pendant/sensor
Pendant: a
personal trigger
worn around the
neck or on the wrist
that can be pressed
if help is needed
Falls Detector:
worn on the belt and
will detect falling
movement and raise
an alert
Bed/Chair
Occupancy
Sensor: provides a
warning that the
user has left the
bed/chair and not
returned within a
set time
Property Exit
Sensor: provides an
early warning the
user may have left
their home during a
set time
Medication
Dispenser:
providers a
reminder for the
user to take their
medication and
raise an alert if they
don't
Bogus Caller
Button: fitted near a
door, this can be
used to call for help
if a stranger
requests entry to the
home
Movement
Detector (PIR):
detects movement
and raises an alert
so the monitoring
centre can check
any long periods of
inactivity or a
possible intruder
Flood Detector:
provides an early
warning by raising
an alert of potential
flood situations in
the home
Smoke Detector:
raises an audible
alarm and sends an
alert so the
monitoring centre
may call the Fire
Service
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Carbon Monoxide
Detector: warns of
dangerous CO, for
example from gas
fires or boilers, so
action can be taken
Natural Gas
Detector: when
natural gas leaks
are detected an
alarm will be sent to
the monitoring
centre
Temperature
Extremes Sensor:
detects low, high or
rapid change in
temperature and
raises an alert.
Epilepsy Sensor:
provides warning of
epileptic seizure
whilst in bed
Enuresis Sensor:
placed between a
mattress and a
sheet, this sensor
provides immediate
warning on detection
of moisture.
Pressure Mat:
monitoring of
inactivity or
intruders dependent
on individual needs.
Pillow Alert:
vibrates to alert a
sleeping user to a
potentially
dangerous situation
e.g. smoke alarm
Key Safe: fits
securely to an
outside wall with a
key inside, so a
responder can
enter the property if
the user needs
help.
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Appendix B – Lancashire case study
Background Information
Margaret is 89 years of age and lives alone. She was diagnosed with dementia two years
ago and is also diabetic and partially sighted. She feels lonely and yet does not usually want
to go out, choosing to stay in the house, unable to occupy herself due to her dementia. She
needs help with her personal care, domestic tasks, finances and medication. She had a small
package of care but most of her support was provided by her son Colin. Colin requested an
assessment for residential care for his mother because the situation was unsustainable. He
said "I feel like I can't cope anymore and my mother isn't safe". He was extremely worried
because his mother had recently been confused and was found wandering in the street one
night. Since then Colin had felt overwhelmed with anxiety.
Social Work Intervention
An overview assessment, mental capacity assessment and carer's assessment were
completed.
A referral for Telecare was made for a pendant alarm, a smoke detector,
medication dispenser and property exit sensors. Margaret's care package was increased and
the timings of her visits were adjusted so she had a regular pattern. She was also issued
with multi vouchers to provide respite to Colin. A referral was made to Shared Lives for
assessment for two hours per week to provide social contact for Margaret and also provide a
break to Colin. A referral to the volunteer service for additional sitting services was also
completed and advice and information was provided on Age UK, Carers Point, Help Direct
and the Alzheimer's Society.
Positive Outcomes
Margaret did not lose her place in the community. She has remained at home where she
wants to live. Admission to residential care has been avoided. Telecare has given Colin
more peace of mind and less stress because he knows that he can be alerted in an
emergency. It is helping to keep Margaret safe in her own home without feeling intrusive.
Her package of care was increased slightly and the timings adjusted, but Telecare has
enabled Margaret to manage between care visits.
In this way it has maximised her
independence. Additional services took the burden of care from Colin, so that he still provides
input but at a level he is able to manage. The additional services have also prevented social
isolation and enhanced social opportunities to Margaret.
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Appendix C – older people population information
The following are projected figures for Lancashire based on population statistics and
(source: Department of Health; POPPI, Projecting Older People Population
Information). The figures relate to older people and illustrate the need to develop
preventative services such as Telecare.
Table a: population aged 65 and over:
People aged 65 and
over projected to
2030
2011
2015
2020
2025
2030
74,700
(+18%)
67,200
72,300
(+14%)
82,100
(+29%)
51,500
56,700
(+10%)
69,800
(+35%)
63,100
(+22%)
68,200
(+32%)
41,600
45,400
50,800
(+22)%
63,000
(+51%)
57,400
(+38%)
37,800
(+24%)
42,900
(+40)%
53,700
(+76%)
23,400
(+26%)
28,300
(+52)%
32,800
(+76%)
63,500
People aged 65-69
People aged 70-74
People aged 75-79
(+9%)
30,500
People aged 80-84
32,800
(+7%)
18,600
People aged 85-89
20,100
(+8%)
9,100
10,900
(+20%)
13,500
(+48%)
17,400
(+91)%
23,200
(+255%)
214,800
240,600
(+12%)
262,500
(+22%)
287,000
(+34%)
317,400
(+48%)
People aged 90 and
over
Total population 65
and over
(+6%)
N.B. The % change compares the base year 2011 to the forecast year.
Table b: older people living alone:
People aged 65
and over
predicted to be
living alone
projected to
2030
Lancashire
% increase over
2010
2010
2015
2020
2025
2030
65-74
75+
65-74
75+
65-74
75+
65-74
75+
65-74
75+
28,320
49,250
33,080
54,246
34,460
61,718
34,040
74,163
37,830
81,735
+17%
+10%
+22%
+25%
+20%
+50%
+33%
+66%
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Table c: older people with dementia:
People aged 65 and
over predicted to
have dementia
Lancashire
2011
2015
2020
2025
2030
14,801
16,365
18,886
22,167
25,986
+11%
+28%
+50%
+76%
% increase over 2011
Table d: older people with limiting long term illness:
People aged 65 and
over with a limiting
long term illness,
living alone
Lancashire
2011
2015
2020
2025
2030
40,860
45,313
51,062
57,744
64,927
+11%
+25%
+41%
+59%
% increase over 2011
Table e: older people predicted to have a fall:
People aged 65 and
over predicted have
a fall projected to
2030
Lancashire
% increase over 2011
2011
2015
2020
2025
2030
56,918
63,424
70,264
77,992
87,938
+11%
+23%
+37%
+54%
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Appendix D – glossary of terms
Assessment
The process of working out what a person's
needs are.
Assistive Technology
Any product or service designed to enable
independence for disabled and older people.
For example, walking aids, bath seats,
stairlifts or Telecare
Carer
A person who provides unpaid support to a
partner, family member, friend or neighbour
who is ill, struggling or disabled and could not
manage without this help.
Commissioning
A person or organisation that plans the
services that are needed by the people who
live in the area the organisation covers, and
ensures that services are available.
A basic assistive technology package of a
pull chord, button, and/or pendant that
enables the user to create an alarm at a call
centre, and most often used in sheltered
housing schemes.
Community Alarms
Extra Care Housing
Offers people the opportunity to live
independently in self contained units but with
access to a flexible and responsive 24-hour
care support service on site.
Fair Access to Care
Services
Guidance on how councils should determine
whether someone is eligible for adult social
care services.
Framework Agreement
A general term for agreements with providers
that set out terms and conditions under which
specific purchases can be made during the
term of the agreement.
Home Care
Care provided in a person's own home by
paid care workers to help them with their daily
life.
Integrated Care
Joined up, coordinated health and social care
that is planned and organised around the
needs and preferences of the individual, their
carer and family.
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Intermediate Care
A range of integrated services to promote
faster recovery from illness, prevent
unnecessary hospital admission, support
timely discharge and maximise independent
living.
Long Term Conditions
A condition that cannot at present be cured,
but can be controlled by medication and other
therapies. Examples are diabetes, heart
disease and chronic obstructive pulmonary
disease.
Personal Budget
Money that is allocated to a person by the
council to pay for care or support to meet their
assessed needs.
Preventative Services
Services that offer advice, support and
practical help so that individuals can continue
to live their daily life as normal. The services
help prevent people reaching crisis point and
the deterioration of their health or situation.
Procurement
The buying of goods or services.
Reablement
A way of helping a person to remain
independent, by giving them the opportunity
to relearn or regain some of the skills for daily
living that may have been lost as a result of
illness, accident or disability
Self Funding
When a person arranges and pays for their
own care services and does not receive
financial help from the council.
Service Providers
Organisations of all shapes and sizes which
run activities designed to help other people in
some way.
Service Users
People who receive health and social care
services.
Sheltered Housing
Housing for older people that includes some
form of support service.
Social Care
Any form of support or help given to someone
to assist them in taking their place in society.
Stakeholders
People or organisations, which have an
interest in a proposed development or idea.
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Supported Living Schemes
Housing and support arrangements for
people with learning disabilities where
someone rents or owns their home. They
have a say over who they live with if it is
shared accommodation, the support they get
and how they live their lives.
Support Plan
A plan a person develops that says how they
will spend their personal budget to get the life
they want.
Supporting People
Supporting People is the name of a national
programme which commissions and monitors
housing related support services.
Telecare
Equipment that helps to keep people safe in
their own homes, using sensors such as fall
detectors and personal pendants linked to a
monitoring and response centre.
Telehealth
Telehealth is the remote exchange of data
between a patient at home and community
health services to assist in diagnosis and
monitoring, and typically used to support
people with Long Term Conditions.
Universal Services
Services such as transport, leisure, health
and education that should be available to
everyone in a local area
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