Sub Region Project Outline Business Case

Project Name

LincolnshireLD Telecare project- 476

Project Manager- Dave Newton, Fit for the Future Team,

1.Project Description- Learning Disabilities, Telecare

This project consists of two very distinct work streams, with both using Telecare (business case attached). An initial 'pump prime' input of £100k was predicted to elicit savings of £154k. To date this has generated savings of £173k with £103k to follow in the next 2 months, producing £276k. With the resolution of ongoing work, further savings are anticipated which will increase the overall savings to £370k. The project streams have also improving people's dignity and independence within their homes.

1- Oneproject streaminvolved NHS partnership working to supportpeople with learning disabilities to move from medium to low secure via a step down service and eventually into appropriate community supported living (CSL) services.

2- The other project stream focused on people with learning disabilities, throughout Lincolnshire, living in their own tenancies within CSL provision.

Research had identified that many companies within the county were providing waking night services in people’s homes which were traditional rather than necessary services. With the introduction of Telecare these could change to sleep in provision, or be removed completely.

3- The project also encompassed a pilot CSL scheme by the Lincolnshire Assessment & Crisis Intervention service (LAECI) which utilised Telecare as an assessment tool.

2.Project Benefits Delivered

The CSL project stream has delivered various benefits to both the individual people using services and the local authority. Assistive Technology in a number of services has created an opportunity to reassess individual's needs and help refocus the support they have into a more person centred delivery. It has also ensured that staff are only present for support when necessary, therefore reducing the numbers of paid workers in the persons home at any one time. The impact of this should not be underestimated as few people choose to have to share their homes with other people, least of all paid workers. The technology has given each person greater independence whilst ensuring they are safe as the technology will alert carers should the need arise. The introduction of the right technology has also reduced the risk of harm or discomfort that can arise with individuals who have specific health or social needs such as those with epilepsy or are incontinent.

The NHS step down implementation has been part of a process that has supported individuals to step down from private hospitals into a local service and also move nearer to their relatives, rather than living in a high cost out of area service.

Both project streams have supported an increase in the numbers of people with learning disabilities to live safely and independently in their own homes, whilst reducing the costs of complex cases. It has also helped to change the way services are delivered by encouraging minimum intervention by staff whilst maximising independence for people who use our services.

Moves from institutional care towards independent living will also improveperformance on national indicators 136: People supported to live independently through social services, and 145 : Adults with learning disabilities in settled accommodation.

Financially the project was injected from the EMRIEP group with £100k, consisting of £50k capital and £50k expenditure, with the projection of £154k savings

Within the CSL project stream the introduction of Telecare has elicited savings with one company of £140k over 4 houses by allowing the staff provision to reduce from wake to sleep in. 2 other houses are also scheduled to move from wake to sleep in within 2 months producing another £70k. £33k has also been saved with another provider in 5 other houses. This has produced overall savings of £173k, bringing thesavings within the CSL provision to £243k.

Partnership working with the NHS, Step down is predicting savings of £11k per person totalling £33K per annum for 3 people, resulting in overall savings of £243k + 33k = £276k. However at the end of project, 1 person has moved into the step down and elicited savings of £68 / day = £24,800 / annum. Consequently if the savings for 1 person are extrapolated by 3, this may increase the NHS savings from £33k to £74k / annum.

The assessment work by the LAECI team demonstrated a 50% reduction in one person's dependency on paid support and his support should therefore reduce by around £3500 p.a. The work also identified his night time support can move from wake to sleep in, resulting in savings of £25k p.a. in his housing complex.

Since inception the project has encompassed 4 other CSL providers, and overall we are on target to meet annual savings of £370,000.

3.How we did it.

1- NHS- Long Leys

The step down project stream was supported by the East Midlands Strategic Commissioning Group and addressed people in placements both in and out of county, and in private hospital settings. The intention was to move people in medium secure, to a low secure, step down service. The original proposal was to work with an independent hospital, Lighthouse, Healthlinc and install a ‘my amego’ Telecare system into a bungalow within their grounds. Following presentations of the Telecare the independent provider did not feel this equipment would work within their service structure. Consequently they withdrew from the project and NHS partners then sought an alternative NHS LD service at Long Leys court, Lincoln. This service looked to move 4 men through a step down / rehabilitation provision until they were ready to enter the community into a CSL setting. At end of project 1 person has moved in, with 3 to follow.

The equipment used includes epilepsy monitors, bed occupancy sensors, door sensors and the innovative use of a biometric internal door lock system which allows some individuals to gain unaccompanied access to kitchens etc by registering their fingerprint scans, whilst restricting access to other people who have been assessed as being at high risk in these areas.

The staff team offer individuals as much independence as possible whilst implementing appropriate risk management strategies and care plans. The use of Telecare in this service supports the balance between promoting independent living skills whilst providing the required elements of care, treatment and support. The Recovery Star system has been used as the central framework for this process.

Telecare also allows the nursing team the opportunity to safely respect individual needs for privacy and dignity whilst maintaining a safe and supportive environment. One service user is already enjoying an increased level of independence around the bungalow complex compared to his previous placement. Furthermore, due to the use of Telecare, a reduced level of observation is required, which not only enhances cost efficiency savings but supports this service users journey through rehabilitation services towards the future long term aim of supported living.

2- CSL

This CSL project stream initially focussed on one main provider (Dimensions) who support over 59 people with joint tenancies in 15 houses. As the project became embedded into the Fit for the Future team’s development work with other CSL providers it became apparent that Telecare could enhance other people’s lives within CSL services whilst producing significant savings to the local authority. Consequently, 4 other care providers were brought into the project, (UBU, Mencap, Massada, Heritage) plus one other provider to be advised following a tendering process for the CSL element of the 'step down' service.

The change from wake to sleep in provision was initially met with a great deal of resistance from staff and relatives, even though most of the people with learning disabilities who had capacity to decide viewed the technology favourably. For those without capacity, assessments, and where appropriate, best interest meetings were held to determine if Telecare was suitable for individuals in their homes.

Development work by the FFTF team showed that, in order for Telecare to be integrated into existing services a change in the expectations of staff, and families was require, especially around positive risk taking. This was achieve by instigating meetings with providers, andholding workshops with providers, care management staff, relatives and service users. During these the FFTF team was clear about the development work, and how Telecare could help to streamline some services. Projected savings were also discussed with providers from an early stage.

Besides savings the introduction of equipment was discussed to improve people’s dignity. For example, It was found that one provider used baby monitors / intercoms for waking staff to listen in to people’s night time activates or staff would sit all night outside a person's open bedroom door in case they experienced a night time epilepsy seizure. The introduction of epilepsy monitors linked to a 'care assist' pager stopped this archaic practise, whilst offering greater levels of safety. Also people who were occasionally incontinent in the night had staff checking them on a regular basis, therefore disturbing their sleep patterns. When installed, incontinent monitors alerted staff only when needed. Consequently night time provision moved from wake to sleep in staff.

Staff and relatives deemed that some people may be at risk if they got out of bed in the night to go to toilet, but failed to return to bed and wandered around the house. Timed bedroom door monitors and bed occupancy sensors, linked to a pager alerted staff to this risk.

Other equipment such as flood detectors in bathrooms and fall monitors meant people could have greater independence but still have the assurance of staff assistance if necessary.

3- The LAECI team found that early use of Telecare in intensive assessments gave a more accurate picture of someone's needs. A 'just checking' system was used which records

a persons night time activity and sleep patterns and then sends the results over a secure connection to a web site. Flood, gas and carbon dioxide detectors were also used to give confidence and reassurance and prevented unnecessary support being put in ‘just in case’.

Bed occupancy mats and the enuresis sensors were also used and removed the need for the person to be ‘checked’ in the night as this was disturbing sleep patterns. These sensors were linked to local staff via a 'care assist' module.

Four people have been supported so far through the pilot and the team have evidenced case studies which demonstrate a 50% reduction in the person dependency on paid support. The person’s outcomes and quality of life also improved.

1. Lessons Learnt

NHS, Long Leys - The use of Telecare has enabled staff to make better use of their time by releasing staff to provide appropriate rehabilitation that is person centred and very much focussed on individual needs.It has also helped staff to respect people’s privacy and dignity by supporting staff to maintain a safe working distance compared to levels of direct observation implemented in previous low secure settings.

CSL-The attitudes and resistance of staff and parents / relatives of people using the service has been a major hindrance and blockage to the integration of Telecare into services. Care management staff have also been risk averse and initially presented resistance to the way care is delivered. Many of these issues have been due to misunderstanding about how Telecare works or that it will not fully replace staff. The notion of ’care on the cheap’, or that changes are solely financially orientated has also had to be challenged. Understanding a change management process has helped to work through these difficulties. Identifying major stakeholders and engaging with them in a positive way as soon as possible has also helped. This has needed a persistent and positive message to be delivered. If done again, more involvement and education would have helped. A road show, or series of live demonstrations may have helped to engage people in this process.

Normally the staff respond to alerts via a Lifeline connect monitor which is linked to a monitoring centre. This project also used a ‘care assist’ module where staff are located within a house and can therefore respond immediately without intervention by a monitoring centre. This unit also has the capacity to record an audit trail for mangers to download onto a computer.

Once equipment had been installed there was a ‘honeymoon period’ to allow staff and service users to become familiar and comfortable with the equipment. During this time the equipment needed fine tuning. More interactive training during installation and a comprehensive manual for staff may have increased some costs, but would have helped to alleviate repeat visits by installers, as use of the equipment was filtered down from one staff member to another which caused some confusion and unnecessary changes to settings on sensors etc.

P1