Telecare in Wales
Lee Davis
Welsh Government
07808 727466
029 2080 1410
Lee.Davis@Wales.GSI.gov.uk
www.ssiacymru.org.uk/telecare
Why is there so
little Telehealth
?
Wales
• Population under 3 million
• 22 Local Authorities
• 7 LHBs
• All Co-Terminus with one or more local authority
So :
• Regionalisation
• Pooled Budgets
Welsh ‘Call Centres’ In 2006
• 22 (23?) call centres mostly only 5,000
connections
• Only one with over 10,000 connections
• Every LA had one
• Costs not known
• Value not known
• Potential not understood
Regionalisation
• North Wales Regional Telecare Service
• 6 local authorities and one LHB working through one
call centre (admittedly on two sites)
• South East Wales Improvement Collaborative (SEWIC)
• 10 Local Authorities and 3 LHBs
• Encompassing Gwent Frailty Project
• Carmarthenshire & Hywell Dda RCT
Sustaining Social Services – A
Framework for Action
•
•
•
•
Regionalisation
Cost
Integration of Telecare & Telehealth
Links with ICES
Telecare to Manage Risk
Environmental
And Security
Social
Medical
Cardiac arrest
Fire
Flood
Nutrition
Cognition
Medication
Gas
Intruders
Mobility
Asthma attack
A Robust Business Case !?
A telecare enhanced care package is on average
cheaper to social services than residential care
only if the package is less than about 20 hours
per week…
A Robust Business Case !?
Random Sampling:
Where institutional care is avoided social care
costs were on average reduced by £216 per
week
Where telecare can mean a reduced care
package at home the cost avoidance is on
average £257 per week
A Robust Business Case !?
In one county studied:
Weekly cost of providing telecare service is under £9 per
user per week – elsewhere probably £12-£15
Across Wales:
On average 3.29 hospital bed days per year per client – a
weekly saving of £14.12 per client
John Bolton’s Work for SSIA
• List of 31 things that local authorities should
do to save money
• Telecare is Number 2 on that list
• After Re-ablement ( – which it can support)
A Robust Business Case !?
Conclusion
The potential for a well targeted telecare service
to reduce costs for social services is
substantial
A Robust Business Case !?
Conclusion
Telecare is not a cost saving panacea
Telecare was developed to manage the risks
associated with independent living, to contribute
to people’s health, mobility, social well-being and
security, and ultimately to provide choice
This should remain its primary goal
People Receiving Telecare at midnight
on 31December 2009
17,946
Total Telecare Service Delivery = 19,699
Community Alarm users = 100,000 approx
Home Care Service Users in any given week = 23-24,000
Would you describe your telecare
service as mainstreamed?
Yes = 20 (17)
No = 2 (5)
(15)
(7)
Telehealth
• We don’t Know how many – counting them now
But
Carmarthenshire RCT = 240
• Main supplier of Telehealth packages in Wales say that
through the Telecare Capital Grant they sold ....
86 !!
Community Alarms
They used :
POTS (plain old telephone system) systems
Personal
Contacts
Existing
Social
Alarm
Monitoring
Monitoring
Centre
Emergency
Services
Passive/Reactive Telecare
It is still :
POTS (plain old telephone system) systems
Personal
Contacts
Passive Sensors in the
home..
Monitoring
Centre
Emergency
Services
Alarms – A Reactive
Telecare System
Wireless alarm
Advanced
Lifeline
Unit
Smart Sensors
Relatives
& friends
Duty
Social
Worker
Out-of-hours Mobile Warden
GP
24 Hour
--Nurse
24 hour
Gas
fitter
Response Team
Rapid
Response
Team
Lifting
service
Community
Alarm
Centre
Fire
service
Emergency
plumber
Police
Ambulance
24 hr. Home Care
Contact &
Coordination centre
Community Alarm Centre
Separate Health & Social Care Systems
Bloodpressure
Cuff
Cholesterol
Monitor
NHS Direct
Scales
Glucose
Sensor
Telehealth Care Record
Pulse
Oximeter
Medication
Tracking
Elderly
living independently
Healthcare Professionals
Home Hub
Appliance
Community Alarm
Centre
Home Automation
Security Wireless Network
• Lights
• Doors windows
• Motion / Activity
• Bed
• Drawers
• Kitchen
• Bathroom
Social Worker
Emergency Services
Coordination
Required
Care Response Service,
Warden etc
Family, friends and
volunteers
Contact & Coordination Centres
Potential Roles:
• Hospital Discharge
• Preventing Admission – co-ordinating services to support at home
• Real Time updating and communication of care plan
• Changing the care package – Responsive.
Telehealth:
• Installation, Maintenance, Administration
• Traffic Light System means clinical involvement only at last point of
process
• This is Mainstreaming Technology !!!
Integration of Services Cost-effectively
County 1
County 2
Home
Response
Response
Team 1
Coordination
& Contact
centre
8am–6pm Mon
- Fri
8am–6pm Mon
- Fri
TELECARE
MONITORING
CENTRE
24/7
Response
Team 4
Coordination
& Contact
centre
8am–6pm Mon
- Fri
County 4
Coordination
& Contact
centre
Clinic
Response
Team 3
Response
Team 2
Coordination
& Contact
centre
8am–6pm Mon
- Fri
County 3
Telehealth on a Telecare Platform
• We are ready
• Seize the moment with the LHBs & Regional
partnerships
• The technology enables us to provide telehealth
monitoring services and telecare alarm services
alongside.
• We need to be proactive and not miss this
opportunity to provide truly integrated services
Cottage Industry Thinking
• How far away are we from turning ‘Community Alarm Services’ in to
‘Contact & Co-ordination Centres‘ which can co-ordinate the
delivery of integrated health and social care services
• We are so far away that Care Line’ services are not being informed
when service users are in care homes or hospital. Many have no
idea where users are unless an alarm goes off
• Does all the required service user information go in to the service?
• Does all the call centre’s knowledge of service users’ needs &
history inform how you can maintain people’s independence.
• Are the ‘Call Centres’ really full players in the delivery of health &
social services
• Are they really part of the mainstream?
• Or are they are still a ‘one-trick-pony’ re-active service?
What We Know & What We Need
Communication Hubs
3 Functions
3 Contexts
Library Function
Call Handling
Care Coordination
National
Regional
Local
Framework of Services for Older
People – 2011
• The focus of this ‘Framework of Services for Older People’
will be upon how these public services work together to
promote the independence of frail older people either in
their own homes or in other homely settings. It will
contribute to the achievement of modern, accessible and
responsive services capable of meeting people’s needs and
of being delivered flexibly, consistently and sustainably
across organisational boundaries. In addition to enabling
people to live as independently as possible, services must
assist them to recover independence where this has been
threatened, must promote and protect their dignity, must
promote social inclusion, must support them at times of
difficulty and protect them from harm.
Framework of Services for Older
People – 2011
The word ‘Telecare’
appears 51 times
Framework for Telecare
• Within the next few months the Welsh Government
will be publishing updated guidance that will build
upon lessons learned over the past five years and will
continue to promote the strategic development of this
service. The guidance will be directed towards
ensuring that we make the best use of telecare and
realise the benefits of closer integration with other
services such as telehealth, community equipment,
adaptations, etc. We also need to exploit the potential
of the communications centre at the heart of telecare
to provide more effective services.
The Social Care Battleground
Question:
What will prevail? -Short term survivalism or
long term sustainability.
Answer:
Organisations will need to work together in
partnership and with innovation if we are
going to meet the challenge to demonstrate
that preventative services are more efficient in
the long run
What We Know & What We Need
The Sustainability & Mainstreaming of Telecare
depends upon the development of a national
comprehensive care strategy that embeds
telecare into health, housing and social care
services
What We Know & What We Need
Pooled Health & Local Authority Budgets to
• Purchase telecare and telehealth equipment
• Integrated data collection & management
• Co-supervision of telecare and telehealth
What We Know & What We Need
National/Regional purchasing strategies with
clear specifications to secure better products
from suppliers
A full-time professional in charge of Telecare /
Telehealth regionally. With a level of authority
and skills
What We Know & What We Need
Better and more consistent training for users,
referrers and assessors
Fully dedicated assessors
Charging policies that remove perverse incentives –
public/private funding strategy ?
A Robust Business Case
Why is Telehealth Delivery so low ?
• This presentation has concentrated on the supply side
• And the received wisdom is that we need get clinical involvement
(esp. GPs) to work through telehealth
• Why aren’t clinicians flocking to it?
• Is it because health care is still too Hospital based>
• But is there a nightmare scenario that service user (patient)
demand is low ?? – have we measured it?
• Is it that telecare is still too ‘cottage industry’ to help?
• Is it that Health & Social care are still not able to work together?
• Or is it just the stage we are at?
Telecare in Wales
Lee Davis
Welsh Government
07808 727466
029 2080 1410
Lee.Davis@Wales.GSI.gov.uk
www.ssiacymru.org.uk/telecare