04 December 2015 – Final Version Technology Enabled Care Programme 2015 – 2018: Guidance for 2016/17 and 2017/18 – Call for Applications Background The Scottish Government believes that the use of digital technology is central to fulfilling Scotland's potential as a nation. Within the context of health, housing & social care, digital technology offers new opportunities for transforming the outcomes and experience of patients and citizens – and of supporting those who care for them. In order to ensure that NHS Boards, Local Authorities, Integration Authorities, and their partners, are fully equipped to maximise the value of these types of solutions and services, the Technology Enabled Care (TEC) Programme was launched in 2014. Formal guidance was issued in October 2014 setting out the objectives and outcomes that the initial tranche of £10 million funding for 2015/16 was expected to achieve. This was set in the context of the new health & wellbeing outcomes for integrated care in Scotland and the Scottish Government and COSLA’s National Telehealth & Telecare Delivery Plan.1 Whilst this document now supersedes last year’s guidance, the latter remains a good reference point for the TEC programme, set within context. It can be accessed here. You can also access an overview of all year-one funded activity here. The main focus of the programme remains on ensuring that outcomes for individuals, in home or community settings, are improved through the application of technology as an integral part of quality cost-effective care and support. The ‘technology’ within this extends to the application of telehealth (including home monitoring and telemedicine/VC), telecare, mobile health & wellbeing applications and the use of online tools and resources to enable greater self-management. Introduction This guidance note sets out arrangements for the allocation of the TEC Programme funding over 2016/17 and 2017/18, totalling approximately £20 million2. A more incremental approach will be utilised for considering submissions and managing the allocation of TEC funds over the next two financial years, which is intended to be more tailored to the circumstances and operational experience of those organisations seeking funds. In practice, this means that we are not looking to commit and distribute all of the funds straight away, and applicants will have time to work with us to fully develop their proposals. We are seeking submissions from organisations3, working in collaboration with their partners who can demonstrate the effective contribution of TEC to the delivery of their key 1 See http://www.gov.scot/Publications/2012/12/7791. We are currently drafting a new version of this, and will be consulting on it soon. 2 Subject to the Scottish Government’s Spending Review on 16 December 2015. 3 See below for eligible organisations. 1 04 December 2015 – Final Version strategic priorities and associated service [re]design. This means that for the next 2 years there will be more significant funding allocated to a small number of organisations focusing on whole system integration, which should include preventative approaches, planned and unscheduled care4, self directed support and wider priorities within community planning partnerships such as Building Safer Communities. We would therefore welcome multi-stakeholder bids covering significant geographical boundaries, with an identified lead partner. We will: Target organisations that have demonstrated a commitment to TEC and have the necessary capability and capacity to deliver an expansion of use within their area. Provide some support to organisations that are seeking to improve their position with regard to the application of TEC. Build on a number of existing ‘at scale’ programmes, such as SmartCare5, United4Health6 and MasterMind7. Our approach has also been informed by the recent report on Critical Success Factors for scaling up technology enabled care (see report here), and we will expect all organisations applying for funding to review their current position against the readiness self-assessment checklist, as last year. Programme Aims & Objectives There are a number of overarching aims and objectives of the TEC Programme whereby we expect applicants to demonstrate their commitment: To improve health & wellbeing outcomes for Scottish citizens; To embed TEC within strategic planning and service (re)design processes; To expand and integrate the effective use of TEC as a sustainable & cost effective component of our health, housing and care services; To promote greater use, integration and sharing of technologies across sectors and services; To raise awareness and promote the digital agenda within health, housing & social care; To achieve sustainable and manageable growth in the number of individuals supported by TEC; To routinely use measurement and evaluation for continuous improvement and service planning. The report of the Independent Review of Primary Care Out of Hours Services (“Pulling together: transforming urgent care for the people of Scotland) was published last week – see http://www.gov.scot/Resource/0048/00489938.pdf. The review highlighted the need for optimal patient care to be ‘underpinned by better use of and access to electronic records, telehealth, telecare and mobile applications…’ Whilst the Scottish Government’s formal response to this will be early in 2016, this may be an area that you wish to consider locally as part of your approach to whole-system service redesign. 5 See http://www.sctt.scot.nhs.uk/programmes/wellbeing/assisted-living/smartcare/ 6 See http://sctt.org.uk/programmes/health/home-based-health-monitoring/united4health/ 7 See http://sctt.org.uk/programmes/health/mental-health/mastermind/ 4 2 04 December 2015 – Final Version We recognise that the TEC funding over this period will not on its own achieve these aims; more resources over a longer period will be required with effective leadership, clarity of vision and objectives, coherent strategy and sustained commitment. As the TEC Programme moves forward there are two important aspects that need to be promoted, namely: 1. TEC should support person centred care within a broader range of support and care services with the focus shifting from the technology (the means) to the care outcomes (the ends). And, 2. TEC should support the focus on preventative and anticipatory care, recognising that while TEC can be appropriate at all levels of need there is greatest scope to make an impact at the high volume, lower care needs level. This is indicated in the diagram below, which shows the Kaiser triangle with the types of TEC inputs indicated against each level. low volume, complex,high cost institutional care limited TEC applications medium level moderate volume care at home or institution- VC consultations, diagnostics, home health monitoring applications Low level, lowcost, high volume care at home focus for TEC - telecare, home health monitoring, info/advice (ALLIS/ LiU) We would expect all applicants to take account of these two characteristics and should consider how the aims and objectives are addressed within their funding proposals. This is covered in more detail under the core assessment criteria, below. Workstreams During the first year of the TEC Programme, development activity was split across five workstreams with a complementary improvement programme alongside. With the original workstream 5 producing its ‘product’ within year one (i.e. the feasibility report into digital telecare), any resultant activities/actions will be subsumed within workstream 4 (telecare) going forward. We have also listened to feedback from participants in the Programme to date, and the Improvement Programme (Delivering our Ambitions) activity will now be a dedicated workstream in its own right as opposed to being an aligned programme of activity. We will 3 04 December 2015 – Final Version increase the resources and capacity of this “Improvement and Support Workstream” to enable a greater emphasis on supporting local improvement and development. The five workstreams going forward are therefore: Workstream 1: Home & Mobile Health Monitoring. Significant work has progressed during year one in developing a specification and service model that is designed to deliver good outcomes and value for money. Participants in this workstream will be expected to utilise, evaluate and further develop this model as a condition of funding. Workstream 2: Expanding the use of video conferencing. In line with the published Scotland-wide VC standards, we are looking to further integrate video links between health, care, third and independent sectors. In particular, we are keen to support the rollout of low cost VC to care homes & sheltered housing developments , develop VC mediated services to citizens in their own home using their own device, and further extend the use of VC for video and online-based clinical consultations (for both primary and secondary care). Workstream 3: Digital Platforms. This is largely a national piece of work, a core component of which will be considering the business case proposal for the implementation of a National Digital Platform to support self-management information, products and services for Scottish citizens. We will remain open, however, to considering further local developments if they fit with national priorities (e.g. further expansion of Living it Up to additional local areas and partners). Workstream 4: further expanding and embedding the use of telecare. The focus of this workstream is largely unchanged, as there is well-publicised international evidence of the benefits of utilising telecare/community alarms. We are keen to support local business planning to ensure that telecare becomes embedded as a core funded service in all areas of Scotland, and to look at responder services. We will also look to support pathfinder projects for implementation of end-to-end digital telecare services as per the recommendations to be published within the feasibility report on the shift from analogue telecare to digital telecare. Workstream 5: Improvement and Support. This builds on the work progressed to date under the ‘Delivering our Ambitions’ Improvement Programme. As well as ensuring that maximum learning from the other workstreams are captured and shared through national events, online resources, webinars, benchmarking etc. we are also looking to make available dedicated resources for local improvement activity. This could include, for example, local workforce development, capacity for support around business planning, data analytics, service redesign, change management etc. We are also looking to see better use of service user generated data to support proactive and preventative interventions, as well as more routine analysis of aggregated user data to inform the design and deployment of services. Applicants should identify their priorities as part of their application, and consider how these can effectively contribute to strategic plans for local whole system design. Whilst a number of initiatives and projects can (and will) be put forward under just one or two of the workstreams (i.e. focusing on one particular technology/pathway etc.), we are keen to see how TEC can be introduced/expanded (etc.) across whole system areas and pathways of care. 4 04 December 2015 – Final Version Consideration will also be given to developing national themes on Dementia 8, falls management9 and home & community safety – developing and rolling out national programmes with partners applying to be part of the team that develops and then implements the agreed frameworks and TEC enabled pathways. Last year, there were a number of proposals that, whilst worthwhile, failed as they were out of scope of the programme, so please read the guidance carefully to ensure your application is within the scope of this programme, and does not naturally fit elsewhere. This applies, for example, to proposals that could be considered as core eHealth business, are too small scale, or more around innovation than delivery. 10 Process This guidance sets out proposals for how years 2 & 3 TEC funding should be developed and allocated in ways that provide continuity and assurance for currently funded projects (where appropriate), but encourages modification in light of emerging evidence and operational experience. The approach will also allow for new initiatives and some national development and support work to be funded. As noted above, the intention is to move away from a single application/allocation date for funding, but to shift toward an incremental approach where funding is agreed to align with progress being achieved and the need for funding to continue is clearly established. This approach will still have to operate within the distinct financial years when funding has to be allocated. This more flexible approach enables decisions to be made around the specific needs and circumstances of each project. In order to access funding, we are inviting applicants to complete Appendix 3 and return by the deadline of 08 February 2016 (at the latest – although we welcome earlier submissions). If the application is within scope (i.e. meets the programme aims and core assessment criteria), we will then work with applicants to further refine their application (if required), with a view to releasing funding once proposals are fully developed and a robust plan is in place. We do not anticipate releasing all funding at this stage, so there will be a further call later in 2016. In all cases those submitting applications are encouraged to make early contact with relevant TEC leads as indicated in Appendix 1 to discuss their plans for the development of their proposals. The advice and assistance available will assist the applicant, will help the TEC Programme Board to get a picture of likely demand for funding, and might assist with early decision-making. Criteria TEC Funding will only be available where it is clear that proposals will improve personal outcomes, deliver at scale, are sustainable and efficient and represent good Including implementation of the ‘Dementia Friendly Technology Charter’ currently being developed by Alzheimer Scotland. See also http://www.qihub.scot.nhs.uk/quality-and-efficiency/focus-on-dementia.aspx. 9 See http://www.knowledge.scot.nhs.uk/fallsandbonehealth/the-national-falls-programme.aspx 10 We will not be funding any proposals relating to the digital transformation of primary care, information sharing or pure innovation. 8 5 04 December 2015 – Final Version value for money. These are the core National criteria we will use to assess all submissions. In addition to the core criteria and the need to demonstrate commitment to addressing the previously identified aims and objectives of the Programme, the following criteria will be applied in assessing applications: Outcomes from investments should lead to a tangible and measurable contribution to ‘whole system’ improvement and service redesign programmes. These will include but not be limited to already established strategic priorities e.g. prevention,, anticipatory care, intermediate care, unscheduled care, outpatient services, discharge planning, dementia care; A clear commitment to embed TEC as part of support and care assessment, care management and discharge planning processes; Clear leadership, governance and programme management is in place; A clear and inclusive approach to stakeholder engagement (including partners, staff, users and carers) has been identified; A description of how and when impacts and benefits will be achieved, evidenced, and sustained has been provided; The contribution to a reduction in demand on other services has been set out e.g. avoiding hospital/care home admissions, reducing lengths of hospital stay and preventing delayed discharges from hospitals; Where appropriate, TEC will be utilised in remote and rural locations where the recruitment of health and care staff can present additional challenges. TEC funding should primarily be used for development and transitional costs (or ‘investment costs’) with continued revenue funding (for recurring costs) identified from mainstream budgets to ensure sustainability beyond the life of the TEC funding programme. In context of work underway on strategic plans, we will continue to expect additional resources to be levered in to support the mainstreaming ambitions of this programme. We will seek to ensure alignment with other developmental initiatives and funding opportunities where there are synergies with the TEC Programme, for instance the programme to enhance digital services within GP practices. Applicants for continued funding should consider if refining their year one aims and objectives and focus of activity and spend might improve the prospects of scaling up and achieving a sustainable position, as well as articulate why additional funding is even required (given that the funding in year one was specifically issued as one year funding only). New applicants should also carefully consider how they could best ensure sustainable delivery at scale of TEC in ways that are fully integrated with wider care and support services, improve outcomes and achieve value for money. Appendix 2 contains a list of funding considerations and questions that you will wish to consider locally prior to applying. Which organisations can apply? Applications can come from any health or social care provider organisation in Scotland. Organisations that do not directly provide health, care or housing services are not eligible 6 04 December 2015 – Final Version as lead applicants, but would be welcome as partner organisations. We would welcome (and encourage) applications from a partnership of various organisations working together. Where partnerships/collaborations are formed, we would expect one organisation to act as the ‘lead’ applicant/organisation and the other organisations(s) as partners. As well as directly providing services, the lead organisation must also be a non profitmaking body. Where a private company or a profit-making organisation is involved as a partner, we would not expect more than a small proportion of the funding to go to this organisation, directly or indirectly, although we do understand that they may be critical to the successful delivery of the proposal. Please submit your completed forms by 08 February 2016 to the central TEC mailbox at nss.tec@nhs.net. Any enquiries related to this guidance, please contact Alistair.hodgson@gov.scot. 7 APPENDIX 1 – KEY CONTACTS In all cases, we strongly recommend that those considering submitting an application make early contact with any of the following to discuss your plans. Home & Mobile Health Monitoring Scott.Henderson@nhs24.scot.nhs.uk and/or michelle.brogan@nhs24.scot.nhs.uk Expanding the use of Video Conferencing hazel.archer@nhs.net (particularly for technical requirements), Sue.Scotland@nhs24.scot.nhs.uk and/or cathy.dorrian@nhs.net Digital Platforms Keith.Willcock@gov.scot (relating to the overall digital platform framework) or russell.scott@nhs24.scot.nhs.uk (for Living it Up) Expanding & Embedding Telecare Sue.Scotland@nhs24.scot.nhs.uk, dkawatson@hotmail.co.uk (Doreen Watson) or russell.scott@nhs24.scot.nhs.uk (for digital telecare) Improvement & Support Susan.Bishop@gov.scot, Michael.Fox2@gov.scot and/or Lesley.Middlemiss@gov.scot. Strategic Planning/‘whole system’ approach cjandyselk2@icloud.com (Colin Anderson) Executive Leads Margaret.Whoriskey@gov.scot (Programme Director), Eddie.Turnbull@gov.scot and Moira.Mackenzie@nhs24.scot.nhs.uk. Programme Contacts alistair.hodgson@gov.scot, aleithead@nhs.net (Programme Manager) or NSS.TEC@nhs.net (general enquiries). Large-scale Programmes For those interested in building on some of the existing ‘large scale’ programmes mentioned, please contact any of the following: michelle.brogan@nhs24.scot.nhs.uk (United4Health); marlene.harkis@nhs24.scot.nhs.uk (SmartCare); chris.wright@nhs24.scot.nhs.uk (MasterMind); and russell.scott@nhs24.scot.nhs.uk (Living it Up). 8 APPENDIX 2 – Funding considerations Please pay close attention to the criteria set out in the guidance. In addition, applicants should be able to show how they will draw from self-assessment and be able to evidence effective delivery of the following: 1. Demonstrate a commitment to successfully deliver TEC as part of integrated and strategic care planning and demonstrate where this initiative sits within Partnership Strategic Plans or Agency strategies; 2. Show how additional funding will supplement core budgets (including the Integrated Care Fund) to increase the benefits achieved from TEC; 3. Show how governance, leadership and management will be achieved to keep a focus and drive on TEC; 4. Set out how other stakeholders will be engaged (including 3 rd sector, independent sectors, patients/users/carers, clinical/professional staff); 5. Demonstrate how TEC sits with (and within) other care services and supports to achieve a coherent whole systems approach; 6. Describe the reasoning behind the choice of theme or themes to be the focus of the submission; 7. Can inform the development of specific impact measures for the Programme, and their specific contribution 8. Be actively involved in the Improvement and Support work stream to share progress and learning across Scotland; 9. Set out what are perceived to be the key critical challenges that will need to be addressed and initial thoughts on what and how these can be covered; 10. Set out the main opportunities locally to improve the prospects of success and how these can be exploited; 11. Be clear on the main benefits and outcomes to citizens; 12. Indicate the number of users per service that will benefit; 13. Demonstrate long-term plans for sustainability. The following is a list of considerations (in no particular order) that should be made by all applicants in both shaping their proposals and considering what funding is required (and is appropriate). Much of this is detailed in the guidance itself. If in doubt, the TEC Programme office will be available to provide assistance. Consideration should also be given to the findings from your local self-assessment: TEC funding should primarily be used for development and transitional costs with continued revenue funding being from mainstream budgets to ensure sustainability beyond the life of the TEC funding programme. Capacity to deliver – is there sufficient capacity within the local system and specific teams to make the necessary changes and deliver on the proposal? It is entirely appropriate for funding to be requested to back-fill certain posts to ensure adequate expertise and capacity is available to deliver the proposals. This includes: o Costs for both leadership and clinician time This includes staff (both clinical and non-clinical) requiring training, involvement in project teams or implementing the changes and attendance at learning events; 9 o project management for the duration of the funding period (but not service delivery personnel who must be funded locally to ensure long term sustainability); o data collection, analysis and other technical support related to measurement; o supply of technical expertise o communication materials and associated staff time required to promote the use of TEC; Procurement needs to be considered – including anticipated timelines – and consulted with locally. Where possible, please use Scotland Excels “Telecare And Telehealth Technologies (06-14) Procurement Framework”; eHealth/IM&T/IT should be involved in the planning; Are there any privacy issues – will a Privacy Impact Assessment need to be carried out? Strategic impact and buy-in: any proposal must fit with the organisations strategic plan; This is not an innovation fund – rather it is about spreading and scaling tried and tested approaches. By innovation we mean something completely new and novel – if there is sufficient evidence that an approach works elsewhere (either geographically elsewhere or in another service area), and you wish to embed it into your service, then that is a good example of spreading tried and tested approaches (i.e. the innovation has already been done elsewhere); Equally, whilst we actively encourage evaluation and the building of a robust evidence base, this is not a research programme; Does the necessary skillset exist within the team? These may have to include: o clinical/service area expertise; o patient/service user/carer engagement; o technical knowledge of the relevant aspects of the proposal; o knowledge of change management including understanding of human factors; o understanding of methods to capture learning and how to carry out selfevaluation; o measurement/data collection expertise; o project management expertise; o budget management expertise; o communications expertise; o ability to influence wider practice and opinion (for spread); o clear project leadership and accountability for delivery of the project, including financial management; o strong engagement skills and leadership of the project to bring about desired changes in practice (including clinical leadership and clinical practice, if applicable); o high level of skill and experience in the team to measure, evaluate and describe the results of the approach; o drive and commitment to deliver the project successfully within timescales. This list is by no means exhaustive, but does provide an indication of the range of things that we expect to have been considered locally. Experience shows that project/programme delivery can be seriously delayed if these are not considered (and addressed) at the outset. 10 APPENDIX 3 – TEMPLATE FOR COMPLETION Please email the completed template to NSS.TEC@nhs.net by 17:00 on Monday 08 February 2016 at the latest. If you wish to discuss any matter relating to this process, please contact Alistair Hodgson either by email Alistair.Hodgson@scotland.gsi.gov.uk or on 0131 244 3652. [see note 1] Lead Partnership/Organisation and contact details Other Partner(s) (If applicable, including lead contacts) Executive Sponsor/Senior Responsible Owner Details Programme/Project Lead and contact details eHealth Lead (If applicable) Expression of Interest sign-off and date Section 1 – Continuation of TEC funding Please complete Section 1 for continuation of current TEC Year 1 funded areas only (refer to Section 2 for any new area requests) Please describe the area(s) you wish to receive continued funding for What are the reasons behind this continued funding request and how are you ensuring year one funding is sustained and built on?* What more can you achieve with this additional funding? *we need to be satisfied that year two funding is not being used to run a service developed in year one, and that any request for further funding is solely related to development costs only. Section 2 – New funding Requests (If this is for a new funded area only) Funding Proposal Please provide your funding proposal (i.e. what are you going to do – focus area, description, technology used etc.) State of Readiness What is your state of readiness to quickly progress your submission if successful in gaining funding? See self-assessment checklist, referred to in the guidance 11 Section 3 ALL: Please complete for both continued and new area funding requests Current position of TEC within the Partnership/organisation(s) [see note 2] Please demonstrate your track record in the delivery of TEC by providing a brief description of the current strategic and operational position of TEC. Scalability of Request/Benefits & Measurements [see note 3] What do you expect to achieve through this funding? What are the clear, realisable and measurable benefits? Outline how citizens and your partnership/organisation(s) will benefit from participating in the National TEC Programme, and the estimated number of citizens who will benefit. How will this be benchmarked and tracked? How will citizen experience and feedback be incorporated in your plan? Where (geographically/demographic etc.) do you intend to focus funded activity? Why did you select these as focus areas? How will you measure progress, attribute outcomes to activities/inputs, learn, and develop from operational experience? What are the likely key milestones, key actions and interim targets/achievements? How will your proposal(s) contribute to the national health & wellbeing outcomes, HEAT targets, local single outcome agreements etc.? Governance and Management [see note 4] Please show how your governance, leadership and management will be achieved to keep a focus and drive on TEC. Funding Duration Please indicate the duration that you are requesting funding for (6/12/18/24 months etc.) 12 Funding Request Please indicate the level of funding you are seeking from the TEC Programme and how much you will be contributing locally (Match Funding) [see note 5] (please provide as much detail as you can – add as many extra rows as required. Can include staff costs to develop, but not run, services) Funding Area: Total: Sustainability Guarantee [see note 5] How will you ensure services are embedded into core service delivery and sustainable beyond the TEC funded period? Is it/will it be part of your local Strategic Plan/Local Delivery Plan? How will TEC develop long term locally? Funding Requested Local contribution (Match Funding) Total . Any other supporting information? Please use this space to provide any further information you feel would be helpful to support this expression of interest. Note 1 We are looking to work with partnerships and/or organisations/bodies who already: can evidence a commitment to technology enabled care, and embedding it as part of supported care models within core service delivery; work inclusively with all key stakeholders, with a focus on scale and expansion of technology-enabled care; and have good experience to draw on together with an enthusiasm to continue to grow, develop, innovate and lead. There is an expectation that any expression of interest will have the support and leadership of a senior executive, with sign-off at Chief Officer and/or Single Accountable Officer level. Partnerships may wish to make a joint expression of interest with other partnerships. Note 2 This could include an overview of: Range of services provided; Levels of take up and usage; Levels of investment, including current year budgets; Outputs, impacts &/or outcomes achieved to date; Levels of involvement of users/carers in the planning and delivery of existing services. 13 Note 3 This should include how your activity will contribute to the national growth of technology-enabled care, in line with the overall aim of the TEC Programme. In addition, answers should focus on: How will citizens benefit? How many will benefit? How will this be benchmarked and how will citizen experience and feedback be incorporated? Where (geographically/demographic etc.) do you intend to focus activity – why? What do you expect to achieve through the Programme (including the use of other resources)? What are the clear, realisable and measurable benefits? How will you measure progress, attribute outcomes to activities/inputs, learn, and develop from operational experience? What are the likely key milestones, key actions and interim targets/achievements? Note 4 Describe how you will oversee the development and implementation of this Programme, within the context of your own governance and management framework. Is this a new partnership or does it build on existing working relationships? How will it be integrated into your wider governance and management arrangements but also ensure a sufficient focus and drive? How will the project be led and how will other leaders be engaged? How will other stakeholders be engaged (including 3rd sector, independent sector, users and carers, clinical/professional staff)? How will the funded activity be managed and supported? Note 5 It is expected that your Partnership/organisation(s) will be able to show that it is at least matching the level of funding being sought. How will you ensure services are sustainable beyond the funded period? Please also provide a breakdown of costs. 14