Execreporttelecaredec06
Execreporttelecaredec06
REPORT TITLE: A MULTI-AGENCY STRATEGY FOR DELIVERING TELECARE IN MIDDLESBROUGH
BRENDA THOMPSON EXECUTIVE MEMBER FOR SOCIAL CARE AND HEALTH
JAN DOUGLAS EXECUTIVE DIRECTOR
Date 5 DECEMBER 2006
PURPOSE OF THE REPORT
1.To seek formal endorsement of the strategy.
BACKGROUND AND EXTERNAL CONSULTATION
2.Telecare, the use of Assistive/Preventative Technology to help people remain in their own homes, is being introduced across the country at a growing pace. The recent White Paper “Our Health, Our care, Our Say: a New Direction for Community Services” emphasises the need to take full advantage of such technology.
3.Telecare consists of various sensors around the home, which can be monitored 24 hours per day, 365 days a year by a response centre. Such sensors include; bed/chair sensor; gas detector; extreme temperature detector; fall detector; infra red sensor; flood detector; and smoke detector.
4.In order to promote Telecare the Department of Health issued a Preventative Technology Grant (PTG) to Local Authorities in April 2006. This will result in £226,046 over two years being available in Middlesbrough to develop Telecare (£84,990 in Year 1 and £141,056 in Year 2). It is anticipated by the Department of Health that Telecare will become sustainable in the long term through a reduction in usage of long-term residential care.
5.The implementation of Telecare in Local Authorities is being monitored by the Commission for Social Care Inspection through the Delivery and Improvement Statement process. It is anticipated that 170 additional users will benefit in year 1 and 280 people will benefit in year 2 of the PTG.
6.Whilst the PTG is being given to Local Authorities there is a clear expectation that they work in partnership with the NHS, housing, voluntary and independent sectors and service users and carers in developing services. To this end a multi-agency steering group has been formed and this group has developed the strategy. The Group led and facilitated a stakeholder event, including service users and carers, at the Middlesbrough Teaching and Learning Centre at the end of August 2006. The information taken on this day has been used in the formulation of the strategy.
7.Telecare will contribute to a number of important agendas within the Health and Social Care arena:
- The White Paper
- National Service Frameworks for older people and Long Term Conditions
- Self Care.
- Intermediate Care
- Extra care Housing
- Preventing unnecessary admissions to hospital and residential care
- Supporting earlier discharge from hospital
- Valuing People
- Supporting People
- Supporting Carers
8.It is clearly important to have a well-developed strategy in place for the implementation of Telecare in Middlesbrough. Evidence from elsewhere in the country has shown that if done properly there can be significant savings from a reduction on the need for more expensive care such as residential care.
OPTION APPRAISAL/RISK ASSESSMENT
9.Without a clear strategy to take Telecare forward there is a risk that Department of Health targets are not met.
FINANCIAL, LEGAL AND WARD IMPLICATIONS
10.Financial – The financial requirements to implement the strategy will be met in the first 2 years by the PTG. An ongoing evaluation will need to take place to ensure sustainability in the longer term.
11.Ward Implications – All Wards will be affected by the implementation.
12.Legal Implications – No legal implications have been identified at this stage.
SCRUTINY CONSULTATION –
13.No consultation has taken place with Scrutiny although Telecare has been identified as a topic for Scrutiny in terms of its implementation.
RECOMMENDATIONS
14.The Executive Member is requested to endorse the Telecare Strategy that will be implemented through a clear project plan (to be developed).
REASONS
15.The Social Care Department is expected to develop Telecare, hence the introduction of the PTG by the Department of Health. It is not optional.
16.A multi-agency strategy will provide direction for the implementation.
BACKGROUND PAPERS
No background papers were used in the preparation of this report.
AUTHOR: Phil Dyson
TEL NO: 01642 729035
______
Address:
Website:
A Multi-Agency
Telecare Strategy
for
Middlesbrough
November
2006
CONTENTS
1 / Introduction / 3
2 / Definition of Telecare / 3/4
3 / National Strategic Vision / 4/5
4 / The Preventative Technology Grant / 5
5 / Outcomes of Telecare / 6
6 / Outcomes for Services / 6
7 / Defining the Service / 6/7
8 / Implementation of Telecare in Middlesbrough / 7
9 / Response service / 7/8
10 / Staffing Requirements / 8/9
11 / Process Following Appointment of staff / 9
12 / Equipment / 9/10
13 / Installation, Programming & Testing of Telecare Equipment / 10
14 / Eligibility for Telecare Equipment / 10/11
15 / Assessment / 11/12
16 / Charging for Telecare / 12/13
17 / Evaluation / 13/14
18 / Telemedicine/telehealth / 14/15
19 / Sustainability / 15
20 / Key Tasks / 15/16
Appendix 1 – Links with Key Legislation / Policies / Documents / 17-21
Appendix 2 – Telecare Benefits for People / 22
Appendix 3 – People who will Benefit from Telecare / 23
Appendix 4 – Government Targets / 24-25
Appendix 5 – Telecare Pathways for Middlesbrough / 26-28
1.INTRODUCTION
This Strategy sets out Middlesbrough’s response to the Department of Health’s guidelines on the development of preventative technology in social and health care.
For the foreseeable future changes in demography and developments in policy will continue to require changes in the way services are delivered. The Department of Health Green Paper on Adult Social Care, ‘Independence, Well-being and Choice’ recognised that to deliver quality social care and related primary care and support services to citizens, all stakeholders will need to work beyond traditional organisational boundaries, structures and systems.
To achieve this we need to embrace and embed new ways of thinking and working. The use of technology and telecare in particular will be an essential component. It is for this reason that the Department of Health has set aside £80m nationally over two years (2006-2008) to help further forge the ways social care and health economies, working with local stakeholders, can modernise, invest and respond to this challenge.
During 2006 a multi agency Telecare strategy group has been meeting regularly. This document is the culmination of the Group’s work.
2.DEFINITION OF TELECARE
Telecare may be defined as “the continuous, automatic, and remote monitoring of real live emergencies and lifestyle changes over time in order to manage the risks associated with independent living.“ In simple terms, telecare includes sensors or monitors (for example, fall or gas detectors) attached to a community alarm service that triggers a warning at a control centre that can be responded to within defined time-scales.
Telecare can:
- Support professionals in making risk and care assessments by providing them with objective data about the person’s real levels of activity, vital signs and circumstances within the normal environment of their own home and day-to-day living.
- Give people greater control of their own lives by reminding them of tasks they wish to complete or providing information about developing risks. Such applications can support and maintain independence, self-esteem and dignity for the person and provide family and carers with reassurance and peace of mind.
- Enable care professionals to shorten the time period between the occurrence of an event and the delivery of appropriate care interventions. In the case of acute incidents (e.g. a fall with a fracture), timely intervention can reduce the number and severity of secondary complications, the duration and intensity of interventions and the associated costs.
- Play an important role in maintaining independence for people and can also provide effective support for carers alongside traditional healthcare, social care and housing initiatives.
- Enable people to remain in their own homes with increased safety, confidence and independence. Telecare is increasingly being seen as part of a care or support package with related services such as home care.
The application of technology may enable care providers to reduce the number of check visits to vulnerable individuals and substitute some of the time saved with more targeted face-to-face work designed around therapeutic or rehabilitative targets more applicable to the user’s circumstances. In this context, the role of technology is not to replace personal contact but to substitute low input visits with high quality contact experiences.
3.NATIONAL STRATEGIC VISION
Telecare was specifically endorsed by the Health Select Committee in July 2002 – The report recommends that the Department of Health establishes “a national strategy to promote the systematic development of telecare solutions as part of a spectrum of care at home”. It also calls for the Government to examine ways of facilitating greater uptake of telehealth solutions within both health and social care”.
The Audit Commission published a series of five reports on the ‘Ageing Society’ entitled ‘Older People: Independence and well-being: The challenge for public services’ which examines the ways in which public services support the independence and well-being of older or disabled people in February 2004.
The Government published the Green Paper on social care in spring 2005. This included specific references to telecare as part of a preventative approach. Telecare has huge potential to support individuals to live at home, and to complement traditional care. It can give carers more personal freedom and more time to concentrate on the human aspects of care and support and will make a contribution to meeting potential shortfalls in the workforce.
The Department of Health produced a Health and Local Authority circular in March 2006 confirming the arrangements surrounding the Preventative Technology Grant. It is being provided to enable councils to invest in telecare to help an additional 160,000 older people nationally to remain independent at home (this equates to 450 people in Middlesbrough). Whilst there are no conditions attached to the grant, effective use of the money from the grant will enable local authorities and their partners to achieve key PSA targets around supporting people with Long Term Conditions and improving the patient and user experience. The CSCI Delivery and Improvement Statement will monitor the number of people benefiting from telecare since the introduction of the grant.
In July 2005, the Department of Health published ‘Building Telecare in England’, which supports the circular March 2006 by providing guidance, more detailed implementation guidance and supporting materials (available from
Appendix 1 provides references to the legislative framework.
4.THE PREVENTATIVE TECHNOLOGY GRANT
In April 2006 the Government introduced the PTG, which it is hoped will initiate a transformation in the design and delivery of health and social care services. This includes prevention strategies to enhance and maintain the well being, self-esteem, independence and autonomy of individuals by using telecare to support them to live safely and securely at home.
The Preventative Technology Grant is made to local councils with Social Services responsibilities. The grant is not ring-fenced. The total amount for England in 2006-7 is £30m and in 2007-8 is £50m. The Preventative Technology Grant for Middlesbrough is £88K (2006/07) and £141K (2007/08).
There is no indication of further funding beyond 2008 however, the guidance indicates that the grant is intended to “pump prime” changes in the delivery of mainstream services. Evidence from elsewhere in the country suggests that the need for more expensive packages of care can be reduced, thereby enabling telecare to be sustained through diversion of funds.
5.OUTCOMES OF TELECARE
For People and their Carers
It is expected that a number of outcomes will be achieved through the use of telecare in the community. These are:
- That people have more choice about their future living options as a result of the availability of a Telecare Service.
- That people are able to remain in their own homes longer than they would otherwise as a result of a Telecare Service.
- That people feel more secure and safer in their own homes as a result of a Telecare Service.
- That people can be prevented from going into long term care or hospital as a result of a Telecare Service being provided.
- That people can be discharged from hospital earlier as a result of a Telecare Service being provided.
- That people are able to receive a timely and appropriate response to their needs following activation of Telecare sensors or detectors.
- That carers feel more confident about their relatives / friends being at home, with the knowledge that a quick response will be made should Telecare sensors or detectors be activated.
The Telecare benefits for people are outlined in Appendix 2and 3
6.OUTCOMES FOR SERVICES
Appendix 4 outlines Government targets and the perceived benefits to services in relation to the implementation of Telecare Services.
7.DEFINING THE SERVICE
The components of an effective telecare service are:
- Assessment – with the person being at the centre of the process, a clear assessment of need and risk and where telecare is the most cost effective method of meeting the identified situation. This may often be part of an overall package of care.
- Provision of equipment – reliable, well-tested equipment that has the ability to meet identified risks and be easy to fit and remove.
- Fitting - where fitting/removal is prompt, skilled and geared to each individual’s needs and understanding.
- Monitoring – 24 hour monitoring of the equipment that is able to differentiate specific users and specific alarms, even using different manufacture’s equipment.
- Response – an individual response plan developed with the person and/or carers.
- Review - where the use of equipment is reviewed to ensure it is still appropriate to the identified need.
- Charging - where the charging process is clear and transparent and supports those with least financial resources.
8.IMPLEMENTATION OF TELECARE IN MIDDLESBROUGH
Local Vision
The vision for provision of Telecare in Middlesbrough is that local people have access to both Telecare equipment and an effective response service allowing them to stay safely in their homes for as long as possible.
The need for provision will be determined by a person’s Social & Health Care needs, rather than by age or medical condition.
There are a wide range of people who will benefit from the provision of Telecare equipment, and these include:
people with physical disabilities
people with cognitive impairment
people with mental health problems
people with learning disabilities
people with sensory impairment
people who have fallen or are at risk of falls
people who are frail
people being discharged from hospital with concerns about returning home
people with epilepsy
people suffering from long term conditions with a risk of repeated hospital admissions
Telecare is complementary to, and not a replacement for, the deployment of human resources.
9.RESPONSE SERVICE
Telecare is only effective when a timely and appropriate response can be made. To this end, it is important to have a service available for 24 hours a day, 7 days a week.
A review of the Care Link Mobile Warden Service, completed in July 2006, has resulted in a proposal which will see the Care Link Service integrated with Intermediate Care Services, co-located with Rapid Response Service and Overnight Nursing Services and providing a mix of planned and responsive services overnight. This will ensure that a range of responses is available, but the main response will be via Carelink.
- STAFFING REQUIREMENTS
Within the Carelink review, a requirement to develop and share knowledge in the Telecare field was acknowledged and the appointment of two Telecare Officers was agreed. Their role will be to develop the technical knowledge required and train other Care Link staff on the range of telecare products available, it’s purpose and the installation and maintenance of the equipment. Additionally, they will be available to promote the service to Social and Health Care professionals in Middlesbrough.
Their roles will include:
-Receiving referrals and assessments.
-Participating in joint visit with assessors as required until assessor knowledge base and confidence in Telecare has been gained.
-Providing initial and ongoing training in Telecare and the processes for provision.
-Co-ordinating activities with suppliers, community alarm services, practitioners as required.
-Acting as a central point of contact for professionals and provide information as required.
-Linking with the Contact Centre.
-Arranging procurement of appropriate equipment.
-Visiting clients.
-Fitting and demonstrating equipment (some specialist installation may be needed e.g. Corgi installation for some equipment).
-Reporting on activity.
-Obtaining views from users, carers, and practitioners on progress of project.
-Maximising claims for benefits for users
- There will also be an appointment of a Service Development Officer to lead on the implementation of Telecare in Middlesbrough. The key objectives of this post will be to :
-Develop a business case for mainstreaming sustainableTelecare Services.
-Determine the scope of the initial service.
-Develop policies, procedures and protocols, including consent and ethical position.
-Develop and agree care pathway.
-Develop and agree documentation and assessment procedure.
-Develop systems for equipment management.
-Develop, maintain and analyse information systems to allow evaluation.
-Determine training needs for staff and service users.
-Develop a training plan.
-Review progress and feedback to appropriate organisations.
-Introduce and monitor the project.
- PROCESS FOLLOWING APPOINTMENT OF STAFF
- A pilot project will be conducted to include:
-Core packages and direct enhancements
-Service users currently in receipt of Care Link Services
-Service users identified by OT’s or Social Workers
- An evaluation of the pilot project.
- A rollout of project learning to all identified service users.
12.EQUIPMENT
Four core packages will be available with identified direct enhancements. However, it is possible to mix and match components, tailored to individual needs.
Client issue / Core Package / Direct EnhancementsStability / wandering-night sitting /
- Lifeline 400 / bed sensor
- X-10 light controller (master & slave)
- wandering client sensor
- Passive Infra-red sensors (inactivity monitoring)
- Smoke detector
Dementia /
- Lifeline 4000+
- wandering client sensor
- temperature extreme sensor
- smoke detector
- flood detector
- Natural gas detector
- Shut off valve
- Carbon Monoxide detector
Falls /
- Lifeline 4000+
- Bed sensor
- X-10 light controller (master & slave)
- 2x Passive Infra-red sensors for inactivity monitoring
- Fall detector
- Smoke detector
Safety / Security /
- Lifeline 4000+
- bogus caller button
- 2x Passive Infra-red sensors
- smoke detector
- temp extreme sensor
- Zoning trigger
- Natural gas detector
- Shut off valve
- Flood detector
- In addition, specialist equipment, either stand alone or linked to a response centre, will be available but will be subject to a specialist assessment.
- The core packages and direct enhancements will be stored, managed and maintained by the Care Link Service.
- Specialist equipment will be stored, delivered, managed and monitored by TCES, or the appropriate provider. This could include door entry systems, keysafes, enuresis alarms (Continence Service), epilepsy sensors and lifestyle monitoring (e.g. Just Checking), video door entry system and monitors, stand alone items of equipment, especially those with an individualised response.
13.INSTALLATION, PROGRAMMING AND TESTING OF TELECARE EQUIPMENT