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B4: Making the most of telecare and telehealth
to support people with long-term needs
Speakers: Stephen Johnson
Deputy Director, Head of Long Term Conditions Department of Health
Kevin Alderson
Health and Social Care Policy Director Tunstall Healthcare (UK) Chair: Tim Rabone
Policy and Research Manager Guiness Care and Support
Making the most of telecare and
telehealth
Stephen Johnson
Deputy Director
Head of Long Term Conditions
3
Telehealth Definition
Telehealth (remote care)
Electronic sensors or equipment that monitor people’s health in their own
home. So for example equipment to monitor vital signs such as blood
pressure, blood oxygen levels or weight. These measures are then
automatically transmitted to a clinician who can observe health status
without the patient leaving home. The clinician monitors daily readings to
look for trends that could indicate a deterioration in condition.
4
Telecare Definition
Telecare ( personal, environmental, security)
Electronic sensors and aids that make the home environment safer so that
people can live at home, independently, for longer. The sensors
automatically raises the alarm by contacting, via a call centre, a family
member, friend, neighbour or warden (in sheltered housing). Examples
include pendant/community alarms worn around the neck, bed sensors to
check that someone has got back to bed after going to the toilet at night and
door sensors to alert if an outside door has been left open unintentionally.
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A few facts ……………
• A long term condition is any condition that cannot be
treated but can be managed by medication and or therapy
• In England over 15 m people have a long term condition
with numbers set to increase in the next 5 to 10 years,
especially co-morbidity
• People with long term conditions use 72% of inpatient
beds, 68% of out-patient appointments and 55% of GP
appointments
• Treatment and care of those with LTCs account for 70% of
the total health and social care spend in England, or
almost £7 in every £10 spent
• Achieving better outcomes means working across sectors
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Building the evidence base
• DH funded and ran a pragmatic cluster randomised control trial of telehealth and telecare (Whole System Demonstrator programme)
• Announced in 2006, designed in 2007, launched in 2008 as a two year study
• Across 3 sites (Newham, Kent & Cornwall), 238 GP practices and over 6,197 people – diabetes, COPD and CHD
• Evaluation co-ordinated by 6 leading academic institutions
• Different suppliers at each site, but there were some commonalities:
• common peripherals for conditions (e.g. blood oximeter for COPD)
• readings up to 5 days per week
• monitoring centre
• symptom questions or educational messages
• Sites were rural, urban and mixed – so results will translate
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Headline findings – December 2011
• Telehealth headlines (5 December 2011) show reductions in;
– mortality by 45%
– emergency admissions by 20%
– A&E visits by 15%
– bed days by 14%
– elective admissions by 14%
• Quality of life remains broadly the same
• Despite high cost of kit in WSD (i.e. at 2009 prices of £1500 to
£2000 per patient) utilisation changes show an overall saving of
around £180 per head
• To achieve the benefits needs service transformation
• Patient satisfaction very high - age is no barrier
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Hospital use and mortality during trial
Control group
(n=1584)
Intervention
group (n=1570)
Absolute difference
(95% CI)
Percentage difference
(95% CI)
Admission
proportion (%)
48.2 (n=763) 42.9 (n=674) -5.2 (-8.7 to -1.8) -10.8% (-18.1% to -3.7%)
Mortality (%) 8.3 (n=131) 4.6 (n=72) -3.7 (-5.4 to -2.0) -44.5% (-65.3% to -23.8%)
Emergency
admissions per head
0.68 (1.41) 0.54 (1.16) -0.14 (-0.23 to -0.05) -20.6% (-33.8% to -7.4%)
Elective admissions
per head
0.49 (1.31) 0.42 (0.99) -0.07 (-0.15 to 0.01) -14.3% (-30.6% to 2.0%)
Outpatient attendances
per head
4.68 (6.81) 4.76 (6.74) 0.08 (-0.39 to 0.55) 1.7% (-8.3% to 11.8%)
Emergency
department visits per
head
0.75 (1.58) 0.64 (1.26) -0.11 (-0.21 to -0.01) -14.7% (28.0% to -1.3%)
Bed days per head 5.68 (15.10) 4.87 (14.35) -0.81 (-1.84 to 0.22) -14.3% (-32.4% to 3.9%)
Tariff cost per head
(£)
2448 (4099) 2260 (4117) 188 (-474 to 98.8) -7.7% (-19.4% to 4.0%)
Source: Effect of telehealth on use of secondary care and mortality: findings from the Whole System Demonstrator
cluster randomised trial (Steventon A and others) BMJ 2012;344:e3874 doi: 10.1136/bmj.e3874
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Understanding what WSD tells us
• A better quality of care, lower mortality rates and reduced unplanned
hospital admissions are within reach
• Busts the myth of lower quality of life as a result of isolation
• Cost benefits are achievable – we need to get the price point right
• Technology alone does not bring the change – you need service
transformation
• Patients on the whole like this type of intervention and age is no barrier
The key is service transformation with technology
Not buying the kit
10
What next
and
How do we get
there….?
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Barriers to telehealth
Market
Building
Quality
Standards Organisational
Readiness
Awareness
Levers &
Incentives Evidence
&
Business
Case
12
Looking ahead to the future
• People will live longer, with more LTCs especially multiple co-morbidities
• More freedom and choice will be the norm
• Today’s teens/twenty-somethings will be tomorrow’s decision makers and healthcare users they are growing up with technology (average age of video gamer in USA is 37)
• People will want to live their lives as they want, with fewer hospital visits, not tied to clinics of bricks and mortar and will see technology as common place
• Telehealth will play a major role in that future - the question is not ‘if’ it will happen but ‘when’
• In 30 years time we will look back in disbelief at how we use hospital
beds
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Three Million Lives
• Not a traditional campaign – we are not setting national targets
• Will need a new offer from industry (low capital cost, revenue based with risk share)
• Will mean NHS/social care responding to that offer by building different service models
• Government will need to create the right environment for success
• Will mean growing awareness and support amongst patients & workforce
• This is about transformational change
Improve 3 million lives within 5 years
www.3millionlives.co.uk
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Roles and Responsibilities
• Government – New tariff for assistive technology
– Make it a priority in NHS Operating Framework
– Delivery linked to CQUIN
– “How to Guides” and implementation support (framework contracts, benchmarking for costs) for the
NHS and social care
• Industry – Capital investment & technology roll-out
– Partnership development & support
– Interoperability solutions & industry code of practice
– Patient and Professional awareness & marketing (e.g. media campaign)
• NHS – Scope opportunities for use of assistive technology
– Build clinical and operational advocacy
– Engage with industry & key local stakeholder groups (including Local Authorities)
– Trajectories for roll-out in business planning (2012/13)
Supported by an overarching communications programme
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Industry Leadership Group
• TSA
• ABHI
• Intellect
• Medilink UK
• BT Health
• Tunstall
• Technology Strategy
Board
• Air Products
• Harmoni
• Philips
• Telehealth Solutions
• Bosch
• Peaks and Plains Housing
Trust
• S3 Group
• Cisco
• O2 Health
• Pfizer
• Care Innovations
• Circle - Invicta Telecare
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Our Legacy
• People in control of their lives
• More freedom and choice
• People will live their lives as they want, with fewer hospital visits,
not tied to clinics of bricks and mortar and technology is common
place
• More flexibility for carers
• Better decision making
No doubt in my mind TH/TC will transform healthcare and lives
We can lead or we can follow
Telehealthcare – bringing care home
Making the most of telehealthcare to support people with long term needs
Kevin Alderson,
Public Sector Policy Director, Tunstall Healthcare
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Objectives for this session
• What is telehealthcare?
• Implications for housing providers
• Case studies
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People in the UK living with a chronic condition*
1 in 3 in the UK live with a Long Term Condition
Source: *Chronic disease management”, Dept of Health, May 2004 **HSE web-site
Current health
interventions can control chronic
conditions not cure
DIABETES 2.2 million diagnosed and 1 million
undiagnosed
ASTHMA 3.7 million and 1.5 million children
HEART FAILURE 0.5 million
Conditions where remote biometric monitoring solutions
can help
COPD 1+ million**
Conditions where remote biometric monitoring devices can not help
ARTHRITIS 8.5 million
MENTAL ILLNESS 10 million
DEMENTIA 1 in 5 aged 80+
LEARNING DISABILITIES 1.5 million
PHYSICAL DISABILITIES 10+ million
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How does Telehealthcare work?
Telehealthcare delivery model
Managed Response
Social Care, Housing,
Community Nursing,
Friends, Family,
Therapy, Meals,
Voluntary Services…
Emergency
Response
Response Centre
Alerts and
Reassurance
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Caring for mum with dementia
• Barbara is in her 80s, has moderate dementia and lives alone.
• She had been walking away from her home during the night and her family had been keeping a close watch on her and escorting her home on occasions.
• In addition she had been leaving pans on the cooker unattended
• This was causing a great deal of stress for her daughter and the rest of her family.
THE SOLUTION
• A telecare package was installed including a “property exit sensor” which sent an alert to the 24 hr Careline.
• The operators managed to reassure Barbara and encourage her to shut the door and come back into the house 87 times in a 3 month period.
• Only on 3 occasions were the family called out.
THE OUTCOME
• “Since telecare, I have started to go out again and spend
time with ALL my family, and I know Mum will be ok. The
equipment really gives me peace of mind.”
23
Stephen – managing epilepsy
telecare has enabled independence
• Stephen in his early 20s has epilepsy and suffers around 1-2 seizures a week usually at night
• His mother wants him to live at home and he wants his independence
THE SOLUTION
• We installed a telecare epilepsy package: – epilepsy sensor placed in the bed to alert of seizures at night
– fall detector (body worn device) for during the day
• Both would send an alert to mum (and 24 hour monitoring centre) so she could go to her son’s aid and provide the necessary medication, should he have a seizure.
THE OUTCOME
“I was so pleased with telecare, I agreed to Stephen getting his own flat near the family home.” Stephen’s mum
24
• Tehream is a single mum who cares for her 2 sons, (7 & 12), who are severely autistic and profoundly deaf
• Her younger child is currently in foster care with regular home visits
• Tehream has not had a full night’s sleep for ten years and was finding it increasingly difficult to manage as her son grows bigger and stronger
• She could not have a cooker as the children have an extremely high pain threshold and are at risk of injuring themselves
• Her eldest son left the bath running and flooded the kitchen and both are prone to leaving the house by the windows and doors, causing danger to themselves
Tehream - Caring for children with
mental and physical disabilities
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Caring for children with
disabilities
THE SOLUTION
• A telecare solution that allows Tehream to know as soon as an incident occurs, via a pager during the day and the under pillow vibrator at night.
THE OUTCOME
• “I have been able to get a good night’s sleep for the first time in many years, as I no longer have to stay awake at night worrying about my sons’ activities. I also know I’m not completely alone in caring for my children. They would both be in foster care if it wasn’t for telecare.”
under-pillow
vibrator
Carer Pager
Flood
Bed sensor
Smoke
Property
exit Home
unit
26
Telehealth – Patient’s Comments
A Telehealth unit was fitted in Pauline’s home in December 2009.
“Telehealth saved me an admission to hospital between Christmas and New Year, when there was an abnormal reading on Boxing Day and the following two days. I was really grateful as having to go to hospital would have really spoilt my Christmas.”
“Despite only having the unit for a couple
of months, it has already saved me three
admissions to hospital. After various
abnormal readings my doctor diagnosed a
chest infection and I was prescribed
antibiotics. Before Telehealth I would have
left it too long causing my condition to
deteriorate and would eventually ended up
in hospital.”
A Telehealth unit was fitted in John’s home in March 2010
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And again …. don’t forget the carers…
John's wife said: “Before we had the
Telehealth fitted I was constantly worrying
about John. I would never leave him
alone in the house in case he became
unwell.
“Not only has Telehealth improved John's
quality of life, it has benefited mine too. I
now have more freedom and can pop into
town for a couple hours, knowing he is
safe. I feel a sense of reassurance
knowing that if John feels unwell he can
take a reading and speak to the doctor
over the phone. I would definitely
recommend Telehealth, it has so many
benefits and not just for patients, but also
for those caring for them.”
28
Is all of this available to your clients as
their care and support needs change?
Implications for housing providers
30
As a housing provider……
• What should our approach be to telecare and telehealth services and what are the opportunities?
• Are we securing the efficiencies and service flexibilities that these technologies can provide to enable older people to live well at home?
• What contribution can we make to the integrated delivery of care and support to older people, strengthening our collaboration with health and social care partners to achieve shared outcomes?
• Are we using assisted living technologies to ensure that the housing and/or care ‘offer’ made by the organisation remains robust and viable in the context of an ageing population with of rising expectations but financial constraint?
31
What are the opportunities for housing -
benefits of telecare and telehealth to their org to social care
improved efficiency
supporting service reconfiguration
competitive edge/generating surpluses
reduced repairs and maintenance
tenure retention
supporting independent living and keeping
people in their homes for longer
developing community based services
improved tenant satisfaction
integration of services
maintaining people at home
reducing home care admissions
targeting where need is greatest, eg dementia
delaying the need for residential care
prevention of higher intensive packages of care
reducing falls
managing preventative services/proactive
intervention
to their residents to their family and friends
improved quality of life/lifestyle
safety and confidence
staying at home for longer
prevention of higher intervention
24/7 low level support service
Increased social interaction
family and friends reassurance
support for informal care
reduced carer stress
Increased connectivity to loved ones
to health to the wider community
integration of services
great partner to health
hospital admissions avoidance
reablement
partners to fire, ambulance
voluntary sector support
community safety
local services growth
32
Summary - Strategic advantages of
telehealthcare technology
• There is a wider value of telehealthcare technology in
– improving efficiency, reducing repairs and maintenance, tenure retention, supporting service reconfiguration
– supporting the role of housing in health and social care in enabling integration of services and care, managing proactive intervention and prevention, hospital admission and care home avoidance and reablement
– improving competitive edge, expanding their service offering, winning new contracts and generating services to be applied to other services
– (for residents) supporting independence, enabling them to stay at home for longer, improving quality of life and lifestyle, prevention of higher intervention and support for family members/carers
33
Launching the 1st in series of 3 Board
Assurance Prompts
• The application of assisted living technology to support independence in
1. Specialised housing for older people
2. Specialised housing for adults who are vulnerable
3. General housing
Email me if you’d like copies – [email protected]
This guide was developed by Nigel Appleton, Contact
Consulting and Jeremy Porteus, Housing LIN and edited
by Andrew Corbett-Nolan, Good Governance Institute
34
What is a BAP - Board Assurance
Prompt
• It suggests six key assurance questions that Board Members and Senior Officers might ask of their organisation, together with plausible and less sufficient answers – Eg Have we considered how we may maintain the financial
viability of our specialised housing for older people?
• Maturity matrix to support development and improvement in implementing assisted living technology from basic level to exemplar – Eg Using technology to enhance support and care delivery
• References to examples of good practice and key facts
Case Studies
36
Supporting re-ablement through telecare
by Coast & Country Housing
• Coast & Country Housing has been providing telecare as part of re-ablement packages in Redcar since March 2011. Coast & Country works with Redcar and Cleveland Borough Council
• Telecare for - dementia support, falls prevention/management or home environment safety and security - represents potential cost savings of up to £400 per person, per week.
What makes it work: the central role of housing
• knowledge and understanding of tenants’ needs and expectations
• tailored assessments focusing on independence and management of risks
• well-established contacts and a decentralised structure enables C&C to deliver an efficient service
• awareness raising about the potential of telecare among referring agencies
• clear referral criteria, developed through research and discussions with social workers
• integration with related services and with other healthcare professionals
“Good housing, with person-centred services like telecare, provides independence, stability and reassurance in people’s lives which act as a springboard to better health”
NHF: On the Pulse: Housing routes to better health outcomes for older people
/www.housing.org.uk/publications/find_a_publication/care_and_support/on_the_pulse.aspx
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Bircherley Court / Calton Court
– vision for older people Creating a new life style for older people
• £17 million investment to improve homes and facilities
• Working with Hertfordshire County Council Health and Community Services to provide flexicare housing (extra care)
• Provide a community alarm (telecare) service to over 800 homes across East Herts
Delivering outcomes
• Our two new flexicare schemes will provide a high quality housing option for older people who require a level of care and support
• Telecare is included as a standard component of the flexicare service
• Bircherley Court and Calton Court provides a product that our older customers under-occupying family homes may choose
• Flexicare “does what it says on the tin.” It provides a level of care and support that is responsive to individual needs. An objective of flexicare is to enable independence and ultimately reduce the amount of input necessary
• Reducing social isolation – a fundamental focus in flexicare is to encourage social interaction and opportunities for engagement
