Technology enabled care services

Better care for people with long-term needs

Len’s storyLen is 62, and has cardiomyopathy. He began using telehealth in 2010 to monitor his symptoms at home, in particular his blood pressure, which is often low, and his weight, an increase in which is an indicator that he is retaining fluid.

Telehealth has enabled Len to become much more knowledgeable about his condition, and better able to manage it. If his weight increases he can take additional diuretics in accordance with his self-management plan, and he knows the signs when his renal function is good or bad. Use of the system has also helped Len to reduce his weight to the point where he has recently been deemed clinically fit to go onto the heart transplant waiting list.

Telehealth has also helped the Community Matron to stabilise Len’s condition. Previously he had been admitted to hospital 143 times in nine years, at an approximate overall cost of £357,500. Since telehealth has been introduced he has had no unplanned admissions to hospital, and the recurrent cost saving to the NHS is £250,000 per year.

We used to have a bag permanently packed ready to go off to hospital at short notice. We were so worried all the time, and I used to need a lot of time off work. The system means we understand much more of what’s going on and can manage things at home rather than calling for an ambulance.

Jackie, Len’s wife and carer.

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The challengeTreating people with long-term conditions accounts for 70% of the health and social care budget in England1, and the long-term condition prevalence is set to rise. Finding ways of supporting these patients differently is an urgent and vital part of ensuring the future sustainability of the NHS, as it strives to make £20bn efficiency savings by 2015.

Sources1 Improving the Health and Wellbeing of people with Long-Term Conditions – DH report2 Health and Social Care Information Centre

The NHS and social care have been slow to rise to the twin challenges of an ageing population and increased prevalence of long-term conditions like diabetes. There is now an urgent need to transform how GPs treat people with these conditions, and to support people themselves to take more control over their health.

Professor Chris Ham, Chief Executive, The King’s Fund

Technology enabled care services, which includes telecare and telehealth, is a key enabler for change, and when used as part of a holistic package of care can support the effective delivery of healthcare in the community, increasing levels of self-management, reducing the pressure on acute health care services and improving the patient experience.

Key statistics

More than 15.4 million people in England live with a long-term condition, and this is expected to rise to 18 million by 20251

• 50% of GP consultations relate to a long-term condition1

• 65% of all outpatient appointments and A&E attendances relate to a long-term condition1

• 70% of all inpatient bed days relate to a long-term condition1

• The number of patients attending A&E in 2012/13 increased by 1 million compared to the previous year2

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The impactHaving one or more long-term conditions can affect many different aspects of physical and emotional wellbeing.

As well as often living with chronic pain as a result of their poorer health, people with long-term conditions may experience: • Frequent exacerbations and/or

deteriorating health

• Numerous visits to their GP

• A cycle of admissions to hospital

• Social isolation

• Financial strain due to inability to work

This poor quality of life can also affect carers and family members, who may have to make adjustments to their own personal and professional lives. They may find:

• They suffer from anxiety, depression and insomnia

• The physical, emotional and mental demands are overwhelming

• They feel isolated and unsupported

Lack of effective management and self-management of long-term conditions also impacts significantly upon primary and secondary care:

• GPs’ workload is increased due to frequent patient appointments

• Demands on the limited resources of community teams

• Unnecessary hospital admissions and longer length of stay

• Increasing demand on out of hours services

The challenge to be addressed is huge. To enhance the quality of life for people with long term conditions we need to be thinking beyond traditional models which focus on patients and professionals. We need to have a system that is person-centred, that starts with what is important to the individual and has meaning for them, their families and their lives.

Dr Martin McShane Director Domain 2 long term conditions, NHS England

Parity of esteem blog, england.nhs.uk, 18 November 2013

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Meeting the challengeBehind the statistics are people from all walks of life who want to be treated as a person, not a condition, or a series of conditions who want to be involved in choices about their care and to receive proactive, joined-up services and to be supported at home, rather than hospital, wherever possible.People with long term health and care needs also want to be listened to and to have access to information which helps them make decisions and gives them the confidence to manage their own condition.*

By educating people about their condition and helping them develop strategies to manage it we can enable them to feel confident, and in control, reducing anxiety and empowering them to make informed lifestyle choices which impact positively on their health.

We can give them the skills to understand when professional or clinical contact is appropriate, helping them to work with health and social care teams in an integrated way.

This in turn can deliver improved health outcomes and quality of life, as well as making best use of public resources.

I was in hospital six times since June last year, and recently I started with a bad chest infection which I didn’t realise was happening but the machine did. (Telehealth) has worked for me because it’s stopped me going to hospital.

Keith, who has COPD

* Patient feedback included in Department of Health’s Long Term Conditions Compendium of Information, Third Edition, 30 May 2012

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How can Tunstall help?Supporting people effectively in the community can help to avoid the need for more costly interventions, and in order to maximise the outcomes, services should be integrated and built around the individual needs of the patient.

However, achieving this requires an innovative approach, challenging traditional boundaries between health and social care and facilitating a cultural shift towards prevention, personalisation and empowerment.

Tunstall’s pioneering LifeCareTM managed service model focuses on service and system design, rather than on equipment, telehealthcare acting as an enabler for change. Working in partnership with providers to design service delivery and care pathways which are focused on individual patient outcomes effectively embeds technology enabled care services into an organisation’s culture and enables the delivery of efficient services which are truly person-centred.

Tunstall LifeCareTM is supported by a dedicated team including experienced clinicians, which provides expert guidance on using telehealthcare to improve the management of long-term conditions, supporting the process of stakeholder engagement, deployment and governance and creating a system with the patient at its heart.

As care becomes based around the person rather than the location, the aim is to provide integrated services which create a continuum of care, matching levels of support to the changing circumstances of the user throughout their lifetime.

4. InstallationSupply system and training

8. ReviewUser needs and service evaluation

2. ReferralEstablish robust process

1. AnalysisWho will bene�t most

3. Pro�lingUnderstand individual needs

6. MaintenanceManaged ongoing

programme

7. ResponseEstablish protocols

5. MonitoringConnect to response centre

©Tunstall Healthcare (UK) Ltd 2014

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Olive uses telecare, and if she feels that a seizure is about to start or she begins to feel faint she can press the button on her fall detector. This alerts the 24/7 monitoring centre, who then call her family for assistance. In the event of Olive falling without pressing the button, the fall detector automatically alerts the monitoring centre.

The Blackburn with Darwen telecare service evaluation found that residential care admissions were reduced by 18% (or equivalent to 57 people) in 2011/12. Total net savings achieved were £2.2 million, £300,000 over the target set, made up of £1.4 million savings from the telecare and reablement service and a further £800,000 saved solely as a result of the telecare service.

Olive’s story Olive has epilepsy and is also very frail. She lives alone, with her family residing fairly nearby, and has fallen on a number of occasions due to her condition. When she has a fall following a seizure, she usually blacks out, and is therefore unable to call for help.

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How can technology enabled care services help to improve management of long-term conditions?

Patients/usersNeeds Solutions enable:

Reassurance, One point of contact for all reduced isolation needs

Peer support

Enabled to stay at home

Feel better Understand symptoms

Feel more in control

Reduced anxiety

Earlier intervention

Improved outcomes

Information Better knowledge of own health/treatment

Work with professionals to manage own care

Up to date information

Commissioners/providersNeeds Solutions enable:

Meet targets Better meet JSNA, QOF, COF, CQUIN, QIPP etc

Value for money

Improved outcomes

Demand management Prevent admissions

Accelerate discharge

Reduce bed days

Prioritise care

Manage risk Better safeguarding

Change patient behaviour, aid prevention

Improved/shared information for informed/proactive care

Technology enabled care services help to support people with long-term conditions by managing risks, both personal and environmental, and can help people to remain independent and in their own homes for longer.

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The solutionsOur telehealthcare solutions, used as part of a whole systems approach to support patients in the community, enable improved management of care by monitoring wellbeing on an ongoing basis, leading to effective prioritisation and earlier interventions.

Telehealthcare offers a vast range of solutions which can be combined and configured according to the needs of the individual user, but is often referred to as either telecare or telehealth.

TelehealthRemote monitoring of long term conditions

Definition:

Telehealth involves the consistent and accurate remote monitoring and management of a patient’s health condition including vital signs monitoring, health settings and advisory information, enabling reductions in hospital admissions, early discharge and improved self-care.

How does it work?

Tunstall’s telehealth solution combines software, hardware and devices specifically designed to help people manage their own health in the community.

Patients use mymedic or myclinic telehealth hubs in conjunction with relevant peripheral devices to measure their vital signs and answer health questions customised to suit their condition. This information is automatically sent to the monitoring centre for technical and clinical triage. If results are outside of the parameters set for that individual, their clinician can be alerted, according to protocol. Clinicians are also able to view data remotely at any time, helping to identify trends and informing the ongoing care plan.

TelecareProviding 24/7 safety and security

Definition:

The continuous, automatic and remote monitoring of real time emergencies and lifestyle changes over time in order to manage the risks associated with independent living.

How does it work?

Telecare can work alongside telehealth, providing an effective means of managing risk, thereby helping to provide an alternative to institutional care. Unobtrusive sensors are placed around the home, which automatically raise an alert if they detect a possible problem, such as smoke, gas, flood or fire. The sensors are wireless and can therefore be easily installed and packages altered to provide truly tailored care. They operate on a dedicated radio frequency which guarantees their integrity. Sensors can be configured to raise an alert with an on-site carer, be directed to a mobile phone, or to a monitoring centre where trained operators follow appropriate protocols. This prompt intervention helps to minimise the consequences of incidents, resulting in improved outcomes. 9

The solutions Monitoring

Effective monitoring and triage is a vital part of delivering our healthcare solutions, and this can be undertaken by customers themselves or delivered by a team of trained professionals at our sister company Tunstall Response as part of a fully managed service.

Alerts from telecare sensors, when not directed to onsite carers or mobile phones, will be received at the 24/7 monitoring centre where trained operators will respond according to the protocol in place for that particular service. Depending on the nature of the alert they may try to contact a nominated keyholder or call the emergency services.

Telehealth monitoring is provided using Tunstall’s triagemanager platform, specialist software that supports the efficient delivery of a telehealth service for patients with long-term conditions across multiple pathways and cohorts.

Data from mymedic and myclinic monitors is received at the monitoring centre, and should readings exceed the individual levels set for the patient, the system will prioritise them on the triage screen, using colour-coding relating to the level of risk. A clinician can then be contacted, enabling them to contact the patient to offer advice, schedule a visit or take other action as appropriate. The system has been designed to deliver timely, relevant information, meaning clinicians are able to intervene at an early stage when required, but will not receive unnecessary alerts. Clinicians with relevant permissions can also log in remotely to access data at any time, to identify trends and inform ongoing care plans.

You’re in safe hands Established almost 30 years ago, Tunstall Response provides monitoring services on behalf of over 130 Health Organisations, Local Authorities, Housing Associations, Charities and Police Services across the UK, receiving between 3,500-6,000 calls per day. Tunstall Response is accredited to the Telecare Services Association’s stringent Platinum standard, demonstrating its compliance with best practice in terms of professionalism, competence and service quality. Triagemanager is CE marked as a clinical device and is hosted within the NHS N3 environment, with all identifiable patient data stored within a Connecting for Health (CfH) approved and audited data centre.[

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John is a 21 year old man, with complex needs including profound learning and physical disabilities, and asthma. A high intensity service user, John was considered to be palliative and in critical condition. The strong intravenous antibiotics given to him in hospital to control his asthma aggravated his bowel condition leading to a cycle of admissions. He also contracted C. Diff during his time in hospital.

Telehealth was introduced to help detect exacerbations at an earlier stage, and the system quickly identified that John’s oxygen levels were fluctuating significantly, leading to him being put on a permanent oxygen concentrator to stabilise his condition. Telehealth has helped care staff to detect exacerbations in John’s asthma at an early stage enabling treatment with antibiotics and steroids at home. John’s condition has improved enormously; he has had no further unplanned hospital admissions, thereby avoiding his distress at being in an unfamiliar environment and the possibility of hospital acquired infections. John is now able to go for days out and enjoy weekend visits home.

Significant financial savings were made as a result of a decrease in non-elective hospital admissions from 50 to 0 (£150,000), the removal of 1:1 overnight care (£61,500) and reduced community nurse and GP visits (£32,500).

John’s story

I can’t thank the SEQOL team enough. John’s quality of life has improved so much; he’s back to how he was 18 months ago. Telehealth has basically given me my son back.

John’s Mum

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Tunstall Advisory ServicesThe Tunstall Advisory Service has been specially created in order to provide dedicated support in the design, delivery and sustainability of telehealthcare programmes, smoothing the deployment process and accelerating the benefits. Comprising specialists with extensive clinical experience along with qualified training teams, telehealthcare implementation experts and business intelligence, the team is dedicated to helping commissioners and providers utilise enabling technology successfully, according to the individual requirements of the service and locality.

Working in partnership with providers, the Tunstall Advisory Service provides resource and expertise to ensure pathways are optimised and outcomes-focused, using telehealthcare as an enabler to support the improved management of people with long-term care needs and chronic conditions.

InstallationOur project management team is experienced in delivering a fully managed installation solution, supporting the whole lifecycle process utilising specialist software and trained staff to implement the process from end-to-end, including referrals, scheduling, installation, asset management, battery management, and decommissioning.

Our national network of field service engineers works closely with office-based teams who provide the necessary coordination and support to ensure we meet agreed deployment schedules. Installers provide a complete service, pairing and calibrating equipment, installing in the home and providing full user training.

TrainingOngoing training and education

are the key enablers to a successful large scale telehealthcare deployment. Our LifeCare™ approach will deliver a broad and concerted training and awareness programme to improve knowledge and education across the internal and wider workforce, driving the agenda and delivering uptake.

Our ServicesEstablished in 1957, Tunstall has been delivering pioneering health, housing and care solutions for almost 60 years, and has a track record in delivering some of the largest and most successful programmes in the UK. We have a team of experienced specialists dedicated to helping our customers establish the best means of integrating technology services into the support you offer to people with long term health and care needs.

ClientFocusedServices

Telehealthcare Consultancy Service

Heal

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Telehealthcare Trai

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Ser

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Business Intelligence Service

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St Helens Council and Bridgewater Community Healthcare NHS Trust have been using telecare and telehealth to support people with long-term health and care needs for some time, including the services as part of packages of care to help to increase independence and safeguard service users. More recently they have included telehealth as part of their reablement service, with a myclinic multi-user system at the Brookfield reablement unit. Patients with long-term conditions leaving Brookfield may then be offered the use of one of five mymedic telehealth systems to monitor their signs and symptoms at home.

Les Foster is 82 and has COPD. Following a stay in hospital he was admitted to the reablement service at Brookfield in October 2013, spending two and a half weeks there using the myclinic system. Upon returning home, Les used a mymedic system for three weeks to help monitor his condition as it improved.

He said “The system is a really big help and I really miss it now it’s gone. It makes you manage your condition

better because you have to take your readings every day, whereas before if I felt a bit unwell I would leave it a few days to see how it went before I did anything about it. It gives you real confidence being able to see how things are going with your own eyes, and it’s so reassuring to know someone is looking at your results and will be in touch if something doesn’t look quite right. It’s a brilliant service and I would recommend it to anyone.”

Les’s story

Telehealth has really helped me prioritise patient care; I can log on any time and access the information and see straight away if the observations are indicating that I need to go out and see someone. I used to go to the reablement unit every day but now I don’t feel I need to and that’s freed my time to make more community visits. Telehealth has given me the flexibility to be more responsive to patients’ needs, and its empowering them to take more responsibility for maintaining their own health stability.

Ann Hughes, Reablement Nurse, Bridgewater Community Healthcare NHS Trust 13

triagemanagerTunstall’s telehealth solution is supported by our innovative software platform, triagemanager. Data from mymedic and myclinic monitors is received at the monitoring centre, and should readings exceed the individual parameters set for the patient, the system will prioritise them on the triage screen, using colour-coding relating to the level of risk. A clinician can then be contacted according to local protocol. Clinicians can also access data remotely.

Key features: CE marked and quality assured – European Medical Devices Directive, and ISO 13485 quality system

Integrated – multiple stakeholders can share real-time information

Scalable – supports the delivery of small and large scale services

Auditable – provides full audit trail and management reporting

Flexible – bespoke clinical reporting

Effective – colour coded dashboard prioritises care delivery

mymedicThe mymedic II home telehealth unit is a Class 1 Medical Device which provides patients with an easy means of monitoring their health. Users take their vital signs readings using the peripherals selected for them by their clinician and answer a series of questions about their symptoms. This data is then securely transmitted to a central server at the monitoring centre, either using a standard telephone landline connection, or via the mobile network.

Key features: Accessible – 7” colour touchscreen, large tactile buttons, multi-language audio

Innovative – uses Bluetooth and new Bluetooth Low Energy peripherals, for extended battery life

Powerful – automatic reading re-take and low battery alert options

Class 1 medical device – classified according to the Medical Devices Directive, developed under ISO 13485, EN60601-1 compliant

Secure – all data is N3 hosted

myclinicA portable, multi- user telehealth system that enables multiple patients to access their individual telehealth monitoring programmes using shared equipment in a communal location. Each user can access their individual monitoring plans, taking vital signs readings and answering tailored on-screen health questions. This information will be securely transmitted to a central server at the monitoring centre and can be accessed by onsite staff.

Key features: Portable – weighs less than 2kg

Reliable – medical grade tablet PC with GPRS link and hot swappable battery

Flexible – manual data entry option enabling readings from other devices to be entered onto the system

Secure – all data is N3 hosted and patient ID cards use NHS / CHI / H&C numbers and PIN entry (optional extra)

Accessible – 10.5” screen displaying clear text and on-screen buttons, patient and supervisor modes

Technology enabled care services

Weighing scales Thermometer Blood pressure monitor

Pulse oximeter Glucometer ECG

MyAmie pendantiVi intelligent pendant

with fall detection

CO detector Epilepsy sensor

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Tele

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Technology enabled care servicesTelecare

Lifeline Vi

The Lifeline Vi provides a hub for telecare in the home and is compatible with a wide range of sensors which can be chosen according to the needs of the user.

Users can call for help by pressing the large button on the Lifeline Vi, or by pressing the red button on their pendant anywhere in the home. The call is raised to the 24-hour monitoring centre where caller details (caller’s name, address and relevant medical conditions), are displayed on-screen. The operator is able to communicate with the caller through the Lifeline Vi unit’s loudspeaker/ microphone and decide upon an appropriate course of action, such as calling a relative or the emergency services.

Working in conjunction with a range of sensors, the Lifeline Vi also monitors the environment 24 hours a day for events. Placed discreetly around the home, the wireless sensors detect problems such as fire, flood or gas leaks and automatically raise a local, audible alarm as well as communicating with the Lifeline Vi to send an alarm to the monitoring centre via the telephone line, or to an onsite carer.

Smoke detector Flood detector Gas detector

DDA pager Bed occupancy sensorEnuresis sensor

myworldmyworld is an easy-to-use touchscreen tablet housing a range of applications designed to promote independence, inclusion and wellbeing by providing a safe, simple means of connecting people in grouped living environments with their care providers, friends, family and the community.

With myworld, residents can:

• Manage appointments, such as care visits or property repairs

• Control meal orders and other services

• Get involved in social events and develop skills

• Send/receive messages/emails to keep in touch with family and friends

• Access a photo gallery and information, such as a calendar and news

See Tunstall’s Portfolio for the full range of telehealthcare solutions

InteroperabilitymHealth Assist- is being developed by Tunstall in collaboration with HMA Digital Marketing and the University of Sheffield. An innovative mobile app, mHealth Assist supports healthcare management and independent living for people with long-term conditions by providing personalised healthcare information.

2net™- This collaboration between Tunstall and Qualcomm Life will enable us to extend our provision of technology enabled care services and expand the range of integrated medical devices.

2net Platform is a cloud-based, interoperable system that can connect a wide variety of medical devices and applications, allowing users and their clinicians or caregivers to easily access real-time biometrics data.

t: 01977 660479 e: marketing@tunstall.com w: tunstall.com

©2014 Tunstall Group Ltd. ®TUNSTALL is a registered trademark. mymedic, myclinic, icp triagemanager, LifeCare, iVi, myamie and myworld are trademarks of Tunstall Healthcare Group.

About Tunstall

Tunstall has been delivering pioneering technology enabled care services solutions for more than 50 years, and has a long and successful track record in supporting people with long-term health and care needs, delivering some of the UK’s largest services. Working in partnership with health, housing and social care providers we have transformed the experience of thousands of professionals and empowered millions of service users.

As a British company operating worldwide, we’re passionate about sharing our experience and expertise with organisations around the globe, making a real and positive difference to people’s lives, every day.