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Connected Healthcare Comes Home:

Remote Monitoring & Preventative Care

23rd January 2018

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Introduction to Tunstall

Case studies - proactive and preventative services

‘It’s not about the technology’ – cohort identification, service redesign, benefits management and an holistic approach

Q&A

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795,000 residents supported

in Group Living schemes

Tunstall Healthcare - global capability, local implementation

60 yrs

experience

1.4M directly monitored by

Tunstall contact centres

UK

Global headquarters

+ manufacturing plant

650 FTEs

110,000

monitored by

Tunstall Response

5,000

Connected Health

customers: one of

longest-standing

UK providers

11,000

B2C customers for

Connected Care

253 monitoring centres use

Tunstall software

5.4M users supported byTunstall

digital care pr oducts and

services

12,000

Business

clients

90,000 individual B2C users

pay Tunstall to support them

47

Countries

2,800

FTEs

15 contact

centres224,000 hospital beds supported

by Tunstall’s Nursecall systems

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Digital solutions enabling more efficient and effective care acrossHealth, Social Care and Housing

Independent Living Assisted Living Remote Patient Monitoringand Support

Managed services

Solutions to support carers and users

Enabling people to live more fulfilling lives at home and on

the move

Managed service solutions

Equipment & software provision

Proactive calling & campaigns

Tailored solutions for housing and residential care providers

Enhancing community and security for residents

Installation & servicing of integrated systems

Managed service solutions

Digital & social inclusion

Solutions to support patients in a community setting

Assisting healthcare organisations to manage

chronic conditions

Remote patient monitoring

Patient Support Programmes

Supporting prevention, self-management, track & trend, triage, case management

End to end servicesolutions

Design, Delivery, Development - strategic consultancy,

operational support

Pathway redesign

Engagement & training

Benefits realisation

Triage & monitoring

Software & hardware

Technical support, installation, maintenance

Connected Care Connected Health Tunstall Lifecare

Cross sector expertise

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UK - Market drivers and statistics

Housing Social Care Health

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Case Studies

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Spain–The background

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Spain – key challenges

▪ ECB intervention in 2012 of £100bn

▪ Decreasing national population

▪ Limited Resources – Money /People

▪ Increasing elderly population (65+)

▪ Increasing demand on services

▪ High levels of Social isolation

▪ Difficulty in Co-ordinating services

▪ Implementing a prevention agenda

50.9% 49.1%

46,436,000 population

18.2% of population 65+

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Personalisation and segmentation - the RET model• RET model introduces segmentation and personalisation of the users

• Uses objective and automated assessment system

• Service provision assigned depending on need within single per person cost

• This allows saving of costs without compromising the service quality

Level 1 Level 2 Level 3 High risk

- +Frequency of contact with the service

Active Ageing Campaigns

Complementary technology

Cognitive stimulation programme

Carers support programme

Risk prevention programme

Old model New modelThrough segmenting users, the number of contacts is

reduced and that allows us to offer additional services for groups with specific needs and promote growth with the

incorporation of new cohorts: carers, people at risk of abuse, cognitive impairment, mental health needs etc.

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Barcelona City Council –The model in action

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Service evolution

1,904

11,899

25,762

43,376

49,290

56,915

63,509

69,58674,400

81,306

86,84190,997

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

90,000

100,000

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

From 1,904 to 90,997 users in 11 years

2016: total calls 3,334,093

Incoming calls:

640,960

Outgoing calls:

2,691,714

Automated calls: 1,419

Contactcentre

data

City of Barcelona

• 1.6 million inhabitants

• 342,328 (21.4%) people 65+

− 26% living alone

• 90,997 benefiting from the service in December 2016

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Impact of the service

4.13 4.043.86 3.84

3.413.16

2.99

2016 2015 2014 2013 2012 2011 2010

Dur

atio

n of

sta

y

Year Duration of stay (years)

2016 4,13

2015 4,04

2014 3,86

2013 3,84

2012 3,41

2011 3,16

2010 2,99

Impact of TEC service based on explicit evaluation by University of Barcelona

Duration of stay in the service

User perception before access to the TEC service and after 6 months of service (score from 1 to 10)

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Outcomes▪ The service provides preventative, proactive support for more independent service users

▪ Care services are prioritised and coordinated to ensure effective use of resources

▪ Vulnerable or at risk service users receive increased levels of support, avoiding crises

▪ Reduced costs of care Significantly reduced number of emergencies

▪ Delayed admissions to nursing care

▪ Latest customer survey users gave the service 9.8 points out of 10

Health promotes healthy lifestyles, focused on people with long-term conditions, preventing nursing home and hospital admissions

Safety preventing falls, improving safety, reduction in emergency calls

Inclusion reducing social isolation

Carers reduction in carer emergency calls

€For every Euro spent on telecare, €2.60 was saved by the public administration across Health and Social Care

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Commissioners’ view

“The success of the public-private partnership is due to the relationship we have with Tunstall Televida. They understand our logic, we understand theirs, and we work in partnership together.”Josep Antoni Dominguez, Head of Services to Social Programmes, Barcelona Provincial Council

“We fly the plane while we are building it.”Ester Sarquella, Head of the Operational Committee, Inter Ministerial Plan for Integrated Health & Social Care, Government of Catalunya

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Leveraging our experience:

UK Case Studies

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Partnership working in Lancashire – before

Response

Management

Reporting

SLA

Inventory

Processes

TrainingMonitoring

Centre

Response

Management

Reporting

SLA

Inventory

Processes

TrainingMonitoring

Centre

Response

Management

Reporting

SLA

Inventory

Processes

TrainingMonitoring

Centre

Response

Management

Reporting

SLA

Inventory

Processes

TrainingMonitoring

Centre

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Developing the future model in Lancashire

Response

Management

Reporting

SLA

Inventory

Processes

TrainingMonitoring

Centre

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Partnership working – benefits ▪ All services managed centrally from single contact centre

▪ Single service to commission and manage

▪ Training and workforce development consistent across the

county

▪ Co-ordinated response to alerts

▪ Simplified referral process designed with staff

▪ Single assessment

▪ One SLA

▪ Co-ordinated approach to services (procurement, inventory,

interoperability)

▪ One system and countywide procedures

▪ Integration into social care system

▪ Falls lifting programme with CCG’s

▪ Fire and Rescue – in home safety assessments

▪ Public Health messaging campaigns

HIGHLIGHTS

▪ >7,000 on service

▪ Results indicate that without telecare the following demand would have existed:

‒ Additional home care –29%

‒ Admission to care home – 14%

‒ Hospital admission –26%

‒ More informal care input – 22%

‒ No change to existing support – 10%

AT SCALE CASE STUDY

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Status at 18 months

Service as a ‘First Offer’

‘Instead of’ not ‘As well As’

Right First Time

ASC front line staff and NHS discharge teams part of new model design

Sandbox testing of new processes

500+ front line staff trained

Free service to those eligible under the Care Act

500% growth to 6,500 service users –growing at 400+ referrals per month

Programme of Co-Assessments to embed model

Increase to 49% (from 24%) of telecare only referrals

Working with health economists to build value and sustainability model

✓12 months - Net £1.5m+ saving✓>£12 per person per week saved on homecare

500

1st

+

£

400+

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Blackburn with Darwen HOUSING CASE STUDY

HIGHLIGHTS

• Exciting mix of care, accommodation and technology

• Environment supports independence and is more cost effective than traditional provision

• Financial benefits envisaged to generate savings of around 20% on care and support costs

A new approach to supporting people with complex needs using integrated technologies SAVES 20% ON CARE AND SUPPORT COSTS

• Moorgate Mill - 20 apartments for people with complex needs including physical and sensory, learning disabilities, and some with behaviour that challenges

• Inclusion Housing run site, designed by HB Villages, care provided by Lifeways and technology provided by Tunstall

• An integrated communications, telecare, environmental controls and access control platform, with systems tailored to the needs of the individual

• Includes sensors to detect risks such as falls, fires or floods and aids such as lighting and heating controls, automatic door openers and blind/curtain openers.

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Telecare and reablement, a new approach to social care SAVES £4.95m

• Hillingdon Council’s Adult Social Care team, NHS and Tunstall developed a new model of care, mainstreaming telecare and reablement services, as part of a new adult social care pathway

• Aimed to create a fundamental shift in service provision away from institutionalised care, towards home-based support, risk prevention and early intervention

• A telecare support service was offered free of charge to residents over the age of 80, and for six weeks as part of the reablementservice

• The service could also be purchased by residents in the borough

London Borough of Hillingdon SOCIAL CARE CASE STUDY

HIGHLIGHTS

• 3,300 people benefitted from the service

• Telecare and reablementservice achieved the financial savings target of £4.95m

• Long-term residential / nursing care placements reduced from 8.08 pw to 2.13 pw

• Reduction in homecare hours purchased of 10%

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Tameside & Glossop Community Healthcare HEALTH CASE STUDY

HIGHLIGHTS

The service has resulted in:

• Reduction of inappropriate home visits

• Earlier interventions, avoiding more complex care services

• Hospital admissions reduced from 55% to 34%

• Reduced length of stay in hospital

Using telehealth to support Long Term Conditions Management Team REDUCES HOSPITAL ADMISSIONS BY 38%

• Tunstall, Tameside and Glossop CCG, Tameside Metropolitan Council and Tameside and Glossop Community Healthcare delivering a telehealth service since 2010

• Over 250 patients are supported by home telehealth systems and a dedicated team of nurses from Tameside and Glossop Community Healthcare, the Long Term Conditions Management Team

• Patients use home telehealth systems to monitor their vital signs and answer a series of health-related questions

• Results are automatically transmitted for technical triage by the Local Council’s Community Response Service

• Patient readings verified as being outside their normal limits are reviewed by clinicians who contact the patient and give advice over the phone and/or visit the patient

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Using Connected Healthcare to enable integrated, anticipatory and sustainable health and care REDUCES EMERGENCY ADMISSIONS BY 26% COSTS

• Commissioning plan included a clear objective to establish a more

consistent, person-centred and sustainable model of care for older and

vulnerable individuals in Calderdale.

• Quest for Quality in Care Homes pilot aims to address the variations in

practice across care homes, supporting the delivery of efficient, proactive

care and reducing admissions to hospital.

• The project implemented in three key phases:

1. Real time access for GPs and Quest Matrons to clinical records in the care

homes

2. Telecare and telehealth systems to support prevention, diagnosis and

treatment, improving quality of care and helping to prevent deterioration of

chronic conditions

3. Investment in a Multi Disciplinary Team providing an integrated social and

clinical approach to support anticipatory care planning

NHS Calderdale CCG CARE HOME CASE STUDY

HIGHLIGHTS

• Hospital bed days down 68% yoy

• GP care home visits reduced 45% compared to non-Quest homes

• Emergency admissions down 26% yoy

• Cost of hospital stays reduced saving £799,561

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SEQOL | Telehealth and learning disabilities - John’s story

The challenge

• John is 21 with complex needs, profound physical and learning disabilities, asthma, uses a wheelchair and is fed via a PEG tube

• Lives in a 5 bedroom supported environment with 4 young males

• High intensity service user with multiple hospital admissions often out of hours, where he was given strong intravenous antibiotics which in turn aggravated his bowel condition. Also contracted C.Diff

The solution

• It was agreed that the introduction of telehealth may help to detect exacerbations at an earlier stage and enable them to be treated differently. John’s GP developed clinical management for the care staff to follow if readings indicated a change in his condition

• Telehealth quickly identified that John’s oxygen levels were fluctuating significantly, which lead to permanent oxygen concentrator to stabilise his condition.

The outcome

• Telehealth has enabled his asthma to be controlled as any drops in oxygen saturation are picked up early and he can be treated with antibiotics and steroids as home,

• John’s condition has improved enormously since the introduction of telehealth with no further unplanned hospital admissions

• Management at home also reduced John’s anxiety and distress

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“We are increasing the use of telehealth within learning disabilities and our next step is to develop the use of telehealth within dementia.” Kim Hogan, Community Matron

Telehealth has resulted in:

• Reduced non-elective admissions from 50 (Jul 11 – Jun 12) to 0 (Jul 12 – May 13), a cost avoidance to the CCG of £150,000

• 1:1 overnight care no longer required, reducing costs by £61,500

• Reduced community nurse visits from daily to weekly; at £40 per visit releasing £13,500 of efficiency

• Reduced GP visits from 4 times weekly to once a week; at £100 per visit, releasing £19,000 efficiency to the Practice

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Digitising pathways

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Digital Healthcare Platformpowered by Inhealthcare

Digital Connected Healthcare Platform

AT HOME HOSPITAL CARE HOME ON THE MOVE

TEXTINTERACTIVEPHONE CALL

3RD PARTYWEBSITES

PATIENTAPPS

WEARABLES &MED TECH

CONNECTEDHOME

3RD PARTYAPPS

MYMEDIC IITELECARESYSTEM

HCPAPP

CLINICIANPORTAL (N3)

ICP TRIAGEMANAGER (N3)

CARE HOMEPORTAL

APPPATIENTPORTAL

MONITORINGCENTRE

SOCIAL CAREPROFESSIONAL

HEALTHPROFESSIONAL

HOUSINGPROFESSIONAL

PATIENT CARER FAMILY

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Patient pathway coded in BPMN

BPMN = Business Process Model and Notation

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Rapid service deployment

Digital Care Home

Depression & AnxietyNutrition &

Dietetics

Post-Surgical Tracking

Population Screening

Patient Recorded Outcomes

Digital health lab for new and with-partner services

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It’s not about the technology !

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1.2 million people in the UK are on warfarin, creating 17 million out-patient appointments per year for INR tests

Wigan Borough CCG

• The CCG are moving anticoagulation services out of the hospital and into primary care

− This service allows patients on warfarin to self-test their INR at home instead of attending out-patient clinic, and then for them to receive their new warfarin dose at home

− 100’s of warfarin patients now self-test at home with their dose calculated by their local GP, avoiding 1000’s of outpatient clinic appointments at the hospital

− When assessed, the self-testing patients had a higher level of compliance than clinic-based patients, meaning that the time that their INR was in a safe range increased from 59% to 72%.

Cohort identification & Risk Stratification

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Service Redesign

▪ 251 NHS organisations in Hampshire delivering primary, secondary, community and mental health services

▪ Risk of complexity, inequity and duplication

▪ Complex processes, multiple hand-offs, lack of integration

▪ Investment required in systems and innovation

▪ Technology = addition not substitution

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Service transformation

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1 2 3 4 5 6

Service improvement or transformative redesign ?

1 2 3 4 5 6

1 7 5 2 6

Current State

Service Improvement

Service Transformation

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▪ Designing in effective benefit measurement is critical to service investment

▪ Using benefits data to optimise and improve services is essential to service sustainability

▪ The following must be considered:

What is the benefit being measured?

Who does what and when?

Where can usable information be obtained from?

Engagement with Finance and BI

teams

Joined up approach between ASC,

Health & Housing

Improvement in Systems

Effective Communication

Benefits Management

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Reducing inappropriate admissions

Adults remaining at home / care home post

discharge for 91 days

The cost of care package for SU’s with DT

compared to those without

Average duration of care packages with and

without DT

% of referrals that convert into a service

% of delayed hospital discharges avoided due

to DT

% of avoidable emergency call outs

DT impact on informal carers

Service user satisfaction

% Adults receiving telecare to the number

of Adults with a care service

Cost of carers including the demand on respite care and the impact on

carers health

Benefits – what to measure?

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A more holistic approach

Social Care

HealthHousing

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Connected Healthcare – cross sector integration of care

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Holistic assessment and integrated, proportional delivery transforms services for users and providers

No

. of

con

tact

s w

ith

th

e se

rvic

eHealth and social status

Current Model Connected Healthcare Model

Tracking of the care serviceAdult’s requirement for support

Reactive

support

Unmet needs

No

. of

con

tact

s w

ith

th

e se

rvic

e

Health and social status

Current and Future Models

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Delivering an holistic model for the future

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NHS Primary & Acute Care

Emergency Services

Third Sector

Adult Social Care

Public Health

CONNECTED HEALTHCARE

SERVICE

CARE

CommunityParticipation

WellbeingSAFETY

HEALTH

FriendsFamily

Inclusion

Connected Healthcare - generating sustainable efficiencies whilst supporting demand and capacitymanagement, service rationalisation and delivering better outcomes by connecting services to residents

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Connected Healthcare - outcomes

Patient

• Improves QOL and independence

• Supports wellbeing, safety and security

• Improves medication adherence, self-management, knowledge, confidence

• Reduces hospital visits and admissions

Nurse / Staff

• Enables effective multidisciplinary team working

• Improves prioritisation and efficiency

• Enables early intervention and prevention

• Supports staff knowledge and confidence

• Improves quality of interaction with patient

Organisation

• Improves resourcing, capacity, productivity

• Reduces costly f2f visits

• Enables continuity of care

• Supports service diversification and USP

• Improves tender opportunities

• Supports data collection

Health & Care

• Reduces A&E visits, hospital admissions, demand on GPs/community teams

• Reduces DTOCs, care packages, care home admissions

• Suitable for numerous conditions, cohorts, pathways, care environments

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Thank you!Questions?

Katy LethbridgeBusiness Development Director

Tunstall Healthcare (UK) Ltdm: +447969 105194

e: Katy.Lethbridge@tunstall.com