Assistive Technology Meeting 20/01/10
Chaired by Garry McKay
(Regional Efficiencies Programme Manager, Care Services)
Apologies from Julia Eames (Rutland County Council) and Sharon O’Hara
(Derbyshire County Council).
Introduction
The aim of this meeting is to share information on Assistive Technology/Telecare
projects and discuss ways to collaborate in the future.
John Bolton’s ‘Use of Resources’ paper highlighted the importance of developing
Telecare with Telehealth. Rachel Holynska (Deputy Regional Director Social Care
and Partnerships, Department of Health: East Midlands) identified Telecare as a
regional priority proposal to the JIP. Nathan Downing from Care Services Efficiency
Delivery (CSED) supports authorities to take Telecare forward. This support is
flexible and provides support according to the individual direction each council wants
to go. He has the capacity to work with four authorities in the East Midlands.
Although the other five authorities will not receive intensive support from CSED, they
can still have access to the network of links and information. Garry McKay and
Nathan Downing can only offer advice on development, methods, thoughts,
outcomes and raise the profile of Assistive Technology, rather than make decisions
for the authority.
Action: Contact Nathan Downing if you require time with CSED.
The big wins from introducing Telecare is a reduction in the number of people
entering residential care. Residential care is a big expense. The average spent per
authority on residential care is a 1/3 of the budget. Each residential care placement
costs £40,000 per year. Telecare can help manage unpredictable problems that can
lead to expensive and unnecessary solutions. For example, unpredictable night time
problems can lead to a night sitter. This can be an unnecessary expense and an
inefficient use of resources as the night sitter may not be needed for the whole time.
If the authority cannot manage this, the person would be put into residential care.
However, Telecare is not a lone factor in keeping someone out of residential care.
There needs to be an integration of services. Reablement, crisis response and health
all underpin Telecare.
North Yorkshire is a good example of authorities working together to gather evidence
and persuade directors to implement a Telecare strategy. Sometimes directors wait
for other authorities to complete an evaluation and implement projects. This gives the
authority the confidence to move forward with a project.
Surveillance equipment causes problems with civil liberties, whether the benefits out
way the moral implications for individuals. The figures show that it could cost £1000 a
year for surveillance equipment per person compared to £342 per week in residential
care, and some may say that residential care is more controlling.
Telecare Service
Leicestershire County Council is currently developing a Telecare strategy and a
steering group. The Telecare profile has been raised and is moving out from the
Supporting People Strategy. A joint strategy between Telecare and Telehealth is a
work in progress. The community alarm service is being reviewed and will be
complete by end of 2010, tendered to 2011. They are looking at a single community
alarm centre.
Nottingham City Council has an integrated Telehealth - Telecare service with Sally
Parker (NHS Nottingham City Telehealth Project Manager). There is no strategy, just
a formal project that started with no strategy. There is new money for standalone
Telecare with the PCT. Eventually all will be the Assistive Technology service. There
is buy-in.
¼ million pounds in Telecare a year ago and ¼ million pounds in standalone was
received from Health. There is no strategy and no guarantee from April 1st to pay for
Telehealth. Last year Telecare had an ongoing commitment but ¼ million pounds it is
not enough. This year there will be £100,000 grant in March. There is no structure of
ongoing staff. One call centre committed to pay the charge if there is enough calls
coming through. A specialist response call centre is wanted. SMART clinics work but
there may be a problem if the call centres are regionalised.
Leicester City Council has a Telecare plan. In March 2009 the strategy was updated
and is stand alone. Assistive Technology strategy is not part of Telecare. It is getting
worked into other strategies like Housing. Potentially there will be no need for a
review as it will be part of services across care. Funding is mainstreamed and
response team is mainstreamed. Getting the PCT involved is the biggest concern.
Lincolnshire County Council has an evaluation document complete. They will be
looking at a strategy and have strategy board meeting with other organisations with
various commitments from health. A plan is starting to form; it is a work in progress.
There are figures projected for the next year and the year ahead. Next year health is
coming in. They are giving funds to Health and Wellbeing rather than to Telecare.
The funds will have to be found internally.
Nottinghamshire County Council has an issue with the current strategy because
there has been a refocus of financial priorities due to the change in management
(two tier authorities have these problems). Telecare is an underdeveloped area and
there needs to be a partnership developed with principle providers. There was an
original Telecare strategy and assistive technology strategy. Now there is a shift
towards concrete evidence. There is a joint commissioning strategy with PCT but
Telehealth has not progressed further even after meetings. Funding is a major issue
as there needs to be a degree of certainty and a three years guarantee. As funding
could disappear there is no incentive to move Telecare forward. Community Alarm
projects have been moved to private sectors. A single monitoring centre has been
established but finances result in higher costs than obtainable in the private market.
Northamptonshire County Council has an overview of Telecare strategy. There is a
strategy and Project Initiation Document (PID) for the next three years. This is
imbedded in prevention and intervention. The biggest challenge is the funding
process and involvement of the PCT. There needs to be funding from other streams
and tangible evaluations instead of theories. Funding is needed to allow the vision of
Telecare that is there to be implemented. Currently the only money available is for
staff and is from savings yet to be made. There is a forecast for a change in
administration and the charging element is unclear (is there a charging element on
equipment?). This issue has gone out to consultation.
Derby City Council has no growth or decline in Telecare. The strategy has not
changed from the start when it was grant funded even though now it is
mainstreamed. Health is a barrier as they are sceptical about the cost savings. This
scepticism comes from the lack of evidence to show that Telecare saves an effective
amount of money. It is always said that the money saved is not down to Telecare
alone. There is a limited strategy to seek funding but primarily the current Telecare
strategy is not fit for purpose, it is more of a commissioning strategy than anything
else. The funding currently available is fine, it is the vision and a better use of
resources that is required to move things forward.
Topics Discussed
Health Partnership:
There needs to be a joint development strategy for crisis response, medication
management and the measurement of respective benefit in Telecare.
Medication Management:
Leicester City Council highlights one of the problems medication management
presents. Pharmacists are on board with the project and Boots charge £20. However
50% of service users do not have to pay for their service package, which makes this
project unaffordable.
Action: A medication management business case is needed, Worcester Council may
have one. This can be lifted and replicated across the region with TASS funding or
REIP funding.
Community Alarm Services:
Shires have a problem as there are multiple partnerships to deal with in the region.
There is a possibility of outsourcing response services. A monitoring centre can be
anywhere. The costs will be different if bring together councils, but this is difficult.
Leicestershire have a contract under review and out to tender until next year.
Nottingham City Council have no contract just a service level agreement.
Lincolnshire County Council has no information.
Nottinghamshire County Council are waiting for the Supporting People project to
decide.
Northamptonshire County Council: Tender for a full social response next year.
Derby City Council has no contract just a service level agreement.
Collecting Evidence:
Currently the way evidence is collected in each authority is unique. Also, collecting
evidence from one supplier does not build a strong case. Sharing information will
help build evidence and cases to support the use of Telecare. When collecting
evidence to prove the financial savings of Telecare, Telecare data needs to be
picked apart from other influences. However, as an example, the evidence currently
shows that no one thing can prevent someone entering residential care. It is difficult
to cut proportions of efficiencies when all are needed. Also, the benefits of Telecare
can be seen in 2 to 3 years time not 1. This makes it difficult to prove efficiencies and
savings in one year.
Within Leicester City council there was a report to show what would happen in 20
random cases if Telecare was not available. This evaluation compared home care
and residential care but the evidence was not considered robust enough and was
time consuming. Essex council also completed an evaluation similar to this. The
Telecare Service Association (TSA) should help with case study evaluations and
searching for evidence to prove Telecare use can create efficiencies.
Service groups Dementia and Older People are easy groups to gather evidence and
prove that Telecare implementation is good. Other groups aren’t as easy to help and
show evidence to support the use of Telecare.
Community Care Assessments:
Telecare should be the default service and on the frontline but it isn’t always included
in the community care assessment across authorities. In Essex, the reablement team
knows about Telecare and trains other social care teams to use it.
Telecare Strategies:
One strategy cannot be used for each authority but sharing strategies can allow an
authority to make a personal strategy. Sometimes it will not be possible to find a
strategy as an authority went forward without one.
Monitoring Centres:
Monitoring centres can technically be anywhere. Councils could join together in one
centre but a larger workload may cause other problems. Local monitoring centres
provide a more personal service. A professional approach, such as the Tunstall
centres are driven by the number of calls answered and do not provide a good
service. They are scripted and some say uncaring. This shows that outsourcing can
be expensive if care is to be valued as well as cost. The question is whether the
premium charge for local service compared to outsourcing is made up by the quality
of care and efficiency this service provides. A clinical approach may not keep people
at home but a local response service must work well to send people in the right
direction for help. There is a national provider that wants to provide monitoring
centres across the country and is going into home care business.
Nottinghamshire County Council has found that inexperienced staff results in higher
costs because expensive services are requested when they are not always
necessary. Faults may not be rectified quickly and cheaply, which leads to expense
and a reduction in service quality.
Summary and Actions
There are examples of the strategy some national/senior authorities used to
mainstream Telecare and put it at the front of services. There are some practical
issues regarding Telecare such as:
1. Charging policies; there are 130 charging policies already online available
2. Equipment; provided by different suppliers and the only information is from
the biased salesperson. Users should share information on the best practice
3. Decommissioning and refurbishment; how should this be done? Pay
external? How much?
All these issues present the question, what is the best mechanism to share
information?
Equipment Directory:
This should be like a review page where people can feedback about products used.
Most people have said they only have time to answer queries if they come directly to
their accounts rather than logging onto a separate forum. The most efficient method
would allow queries to be sent out to everyone and answers archived to prevent
people repeating questions. This distribution network will only work with a small
number of people.
Information for collection and distribution:
 Telecare strategies – helpful for authorities to see a direction to the
service and highlights communal themes




Evaluations and appraisals of Telecare Service
Medication management policies
Charging policies
Good case studies
Action: Develop a mechanism to share experiences and post questions to problems.
Action: Agree to a common approach for data collection so it is possible to compare
information between authorities. Nathan Downing could speak to a data
analysis (Kim)
Action: Discuss Personalisation at future meetings
Action: Garry to bring up issues at the next JIP meeting and share information from
Matt Bowsher with everyone
Next Meeting: in 3 months, week commencing 12th April. Date to be confirmed.