Prevention and early intervention – Spanish model

What challenge did Barcelona face?

Barcelona has an ageing population, with an associated increase in people with long-term health and care needs. The Spanish economy has been weak in recent years, leading to cuts in central funding and the requirement for councils to deliver more for less.

What would have happened if a new model of care wasn’t found?

The new model uses teleassistance to provide targeted support to people before they become more dependent, aiming to postpone and prevent the need for care by offering psychosocial support. Without the new approach a greater number of more complex interventions are likely to have been required, putting more pressure on statutory services and meaning a poorer quality of life for many older people in the region.

Although some monitoring centres have been undertaking proactive calling over recent years, scalability can be an issue.

How did you go about changing the model of care in Barcelona?

In Spain, the law has guaranteed access to telecare since 2006. Economic austerity has led to individual local authorities in Spain being given control over their budgets and therefore their provision of telecare; Barcelona Council has chosen to continue to fund a teleassistance service.

What process did you follow?

The Televida teleassistance service combines telecare monitoring and response, coordinates social care and third party services and delivers proactive outbound contact from monitoring centres. Teleassistance aims to provide continued contact and support to older and vulnerable people in the community, helping them to remain independent for as long as possible and delay or avoid the need for more complex interventions. Barcelona's SLT is one example, which has been delivered by Televida since 2005. Commissioned by Barcelona Provincial Council in conjunction with the municipalities in the province, the SLT has grown considerably, from 3,800 service users to almost 70,000 today. Currently 10% of people aged 65 years and over and 25% of people aged over 80 receive the SLT service.

Difficulties faced

The model shows the benefits of commissioning large-scale services with multiple stakeholders; however this requires significant upfront investment and a coordinated approach to be successful. Such services cannot be delivered in isolation or used as a replacement for human contact, but should be used as an enabling tool to support effective care outcomes.

Logistically, Barcelona is a large and congested city and the teleassistance Service Level Agreement requires that responders must reach addresses in Barcelona within 30 minutes, and so motorbikes are used to negotiate busy roads. Each vehicle is equipped with medical equipment and manned by specialist trained social care technicians offering swift support; for example first aid, helping users after a fall and supporting people who feel depressed.

Some of the people supported by the teleassistance service have difficulties communicating, so Televida developed CareChat, which enables them to access the service using smartphones and a decision tree with predefined pictograms and text.

The best thing about changing the model of care

It’s a collaborative approach which leads to truly integrated and therefore efficient care delivery.

What did you end up doing – components of the model

 

 The service provides people who are older and/or have long-term care needs with a range of support including:

  • Monitoring
  • Telecare systems
  • Home care
  • Emergency response units
  • Prevention and wellbeing services 

Including prevention in the delivery model has been a key contributor to the success of the teleassistance service. It has significantly reduced the number of emergency service escalations, improved the wellbeing of users and made effective use of public services. Operators at the monitoring centre answer incoming calls in an average time of less than 10 seconds, and approximately 60% of calls are outbound. Operators proactively call service users on a regular basis to check on their wellbeing, remind them of appointments, prompt them to take medication, confirm medication has been delivered or wish them a happy birthday. The frequency of contact is adjusted depending upon the needs of the individual. Operators will also contact service users who experience a crisis, such as a bereavement, to offer reassurance and assess their mood and health. Special protocols and skilled staff are in place to support service users where there is risk of suicide or abuse, and in the event of major disasters.

Additional service elements

  • Public Health
  • Advanced technologies to support users
  • Inter-municipal network

Who are the stakeholders involved?

When Televida began to deliver the SLT teleassistance service in 2005, it worked with Barcelona Provincial Council and the 310 municipalities in the province to design a unique public service model to support older people and those with long-term health and care needs. By delivering a public teleassistance service under a single contract, public resources are used efficiently, there is greater consistency across the region and innovation is enabled and encouraged. Delivering the service in this way also enables increased cooperation with emergency services, successfully managing crises in the home such as falls, and local situations such as floods, fires and extreme temperatures in a coordinated way.

Televida also provides a programme called Let's Talk (Hablemos de), where operators make calls to discuss public health issues relevant to users, such as tips for fire safety in the home, advice on how to prevent the spread of flu, ways of dealing with periods of warmer or colder weather air pollution, or how to prevent allergies. Televida works with the council and other public services such as health, fire and rescue and the police to refine the advice they give as part of the programme, define protocols and agree prevention/training campaign delivery

What and how is technology supporting you?

Televida uses advanced, bespoke monitoring centre software to manage calls and data, prompting operator workflow and creating an in-depth audit trail.

Lifeline home units and personal pendants are given to service users, enabling them to raise a call for help at the touch of a button from anywhere in their home, 24 hours a day. The teleassistance service can also provide more advanced telecare such as falls, smoke, gas and carbon monoxide detectors and sensors which monitor activity/inactivity. Today there are more than 5,500 of these sensors in operation.

Technology has also been used in Barcelona to support coordinated service delivery by the development of an integrated health and social care record; believed to be the first of its kind in Europe.

What are the main benefits being achieved

The teleassistance model offers tailored support, with preventative, proactive support for more independent service users, and increased levels of support for vulnerable or at risk service.

The model integrates statutory services to coordinate and prioritise care to ensure effective use of resources. The model is focused on providing preventative care where possible, helping to prevent residential care and hospital admissions by improving safety and promoting healthy lifestyles and self-care where possible.

The service also reduces social isolation by using proactive calling, improving wellbeing.

Evidence / outcomes – org, commissioning, people, staff – interviews

Teleassistance provides preventative, proactive support to more independent service users. Care services are prioritised and coordinated to ensure resources are used effectively and focused on the areas where they will deliver the best outcomes. The service has significantly delayed unwanted moves into residential care, and reduced emergency calls from end users and their families which has correspondingly reduced ambulance call outs and A&E attendances.

Examples of results include:

Care Service A

  • 20% reduction in carer emergency calls as a result of carer support services
  • 10% reduction in service user emergency calls
  • Approximately 12 month delay in move to residential care

Care Service B

  • Cost savings of €375 - €1106 per person, per month due to avoided/delayed admission to residential care as a result of combining telecare with other services
  • 99.7% of users reported feeling more calm and safe at home

For the Barcelona SLT service specifically, its latest survey in 2014 saw users rating the service and an average of 9.8 points out of 10. The SLT also obtained, in 2013, recognition as Best Practice of European Public Sector Award (EPSA) by the European Institute of Public Administration (EIPA). The SLT was given an award for developing a successful public-private collaboration model in 2013 by the prestigious ESADE business school.

Future plans

Future plans are to continue delivering the teleassistance service, and expand its use into more areas of Spain.

 

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High cost packages of care – Blackburn with Darwen Borough Council

What challenge did Blackburn with Darwen face?

Blackburn with Darwen Borough Council is ranked as the 17th most deprived Local Authority in England out of 326 on the Index of Multiple Deprivation 2010, and the area faces some significant demographic challenges in the future with the number of people aged 85+ set to increase by 12.5% between 2010 and 2021. The Borough has had one the highest rates of admission to residential care in the North West, and the number of people aged 65+ with dementia is projected to increase by 53% between 2010 and 2030 to 1,910.

Blackburn with Darwen is also home to above average numbers of people with chronic illness (with more than half of the population having two or more long term conditions) and mental health issues, with both groups being high users of health and social care services. NHS Blackburn with Darwen CCG has the fifth highest rate of unplanned hospitalisation for chronic ambulatory care sensitive conditions in England with 1,446 emergency admissions per 100,000.

The challenge of an ageing population and reducing resources is exacerbated by deprivation, health inequalities and poor housing. The Council needed to address these issues in order to manage current and future demand, and improve outcomes for local people. At the same time, budget efficiencies meant considerable savings needed to be made from the social care budget.

What would have happened if a new model of care wasn’t found?

Blackburn with Darwen Borough is experiencing significant changes in the population structure over the coming 20 years with increasing complexity of care needs impacted by deprivation and the number of people over 90 almost doubling. Including Pennine Lancashire the combined funding gap across health and social care in the next five years is in the tens of millions.

With increasing demand, more people becoming dependent earlier on in their lives, much more complexity of need in the people who come forward for support, and cases which take a lot longer for social workers to organise than five years ago, coupled with significantly less money, services had to be delivered in a different way in order to remain sustainable.

What process did you follow to change the model of care?

The North West Joint Improvement Partnership (JIP) (since superseded by Transition Alliance) was formed to drive improvement in social care commissioning and outcomes, health and wellbeing. Working in partnership with a range of local organisations, including the NHS, from 2009, it began to examine a range of options to support the delivery of continuously improving Adult Social Care. The JIP reviewed approaches taken by a number of authorities facing similar challenges and as a result began to consider the way technology could help to improve the quality of life for people in the area.

The adult social care department was charged with making efficiencies of £17M between 2011 and 2015, meaning that the promotion of independence became a crucial driver to the delivery of cost savings whilst at the same time looking to improve user outcomes. Working in partnership with Care Services Efficiency Delivery programme (CSED), the Council put in place a ‘hearts and minds’ engagement programme for stakeholders, identifying barriers to the successful implementation of the telecare service and putting in place plans to overcome them.

A particular concern for social workers was that they would need to manage or might be liable for any problems with equipment should they occur, and this was addressed by ensuring they were clear about the structure and processes in place to support the service. Real life case examples were used as a powerful way of illustrating the benefits and impact of telecare to a wide and diverse range of stakeholders. The change management programme also included an exercise to ensure the referral system was simple and easy to use and that associated processes such as assessment, installation and review were simple, transparent and robust. It was also vital to integrate telecare into the community reablement process and rapid response service, creating a universally accessible service

Difficulties faced

Cultural issues around traditional care and support are also a challenge in terms of risk aversion and a prevailing belief that “more care is better care”, meaning that some people, through the best of intentions, get more help than they might actually want or need.

Another perception that had to be overcome was a belief that telecare replaces human contact; this is not the case and Blackburn with Darwen receives more positive user feedback for this service than any other.

The best thing about changing the model of care

Telecare enables care and support to become more empowering, giving people control over their own lives and the environment in which they live, as well as improving outcomes and being cost effective.

What did you end up doing – components of the model

The Putting People First policy followed by Think Local Act Personal brought an emphasis on prevention and in particular on telecare and reablement. The starting point was not just to look at the financial necessity but also the desirability of keeping people out of care institutions. Managing needs in the community was preferable and telecare was the key to achieving this.

Following examination of delivery models in other areas (particularly North Yorkshire); Blackburn with Darwen Council set objectives for supporting more people to remain independent at home by increasing its own use of telecare.

It aimed to:

  • Increase the number of telecare users from 60 to 1,800 within three years
  • Reduce/delay residential care admissions
  • Incorporate telecare into the reablement process to reduce re-admissions to hospital
  • Provide support to informal carers, improving their health and wellbeing and ability to care for longer in a more stress-free way
  • Achieve overall savings of £1.9m

Who are the stakeholders involved?

Blackburn with Darwen Council works in partnership with the provider, health and housing providers and the third sector.

What and how is technology supporting you?

Most people supported by the service will utilise a Lifeline home unit with personal pendant, and other telecare sensors according to their individual needs.

In the case of Moorgate Mill, more advanced technologies are needed. Moorgate Mill was officially opened on July 7 2015 and consists of 20 apartments adapted to meet the needs of adults with complex needs including physical and sensory, learning disabilities, and some with behaviour that challenges. The innovative complex has been fitted with cutting-edge adaptive technology including telecare sensors, telehealth systems and access control, so that tenants can benefit from state-of-the-art care solutions to support them now and in the future.

Everyone has a personal budget that is split 3 ways:

  • First element is common background support for everyone. Staff are there 24/7 in the background and can be called on when needed.
  • Second is the personal care package – individual one to one personal care tailored to individual needs and based on a support plan.
  • Third element is for the advanced assistive technology.

Moorgate Mill is an exciting mix of care, accommodation and technology designed to create an environment that supports independence and is more cost effective than traditional provision. The traditional approach of supported living with three-to-four people living together is no longer the best approach and its financial viability is in serious question given local government cutbacks. Moreover, people in small group homes often have little or no choice with whom they live, whereas Moorgate Mill allows a better balance of individual living with the choice to have communal living when tenants want.

What are the main benefits being achieved

The service helps to achieve the aim of keeping as many people as independent as possible for as long as possible, delaying or preventing the need for social care services.

Evidence / outcomes – org, commissioning, people, staff – interviews

The number of telecare service users in Blackburn with Darwen has increased from 60 in 2010/11 to 1,910 in 2013/14. The Council undertook a robust evaluation of the service with assistance from CSED, tracking results by individual service users and reporting outcomes monthly and quarterly. Each social worker noted the alternative outcome had telecare not been in place in order to assess the impact of the service. This was in turn used to calculate cashable and cash avoidance savings in detail. The evaluation covered the year period 30 June 2008 to 30 August 2010, and 114 service users in receipt of telecare were used for the evaluation, of which thirty four received no other services.

In considering the outcome of telecare, 56% (64) of installations are purely to support prevention, either on top of an existing care package or provided to people who would have received no other services. In these instances there would be no immediate alternative to telecare. Telecare provided to the remaining 50 people avoided the escalation of care as follows:

  • 1 escalation of 24 hour care
  • 2 residential/nursing continuing health care
  • 1 increase in day care
  • 29 home care
  • 2 nursing care
  • 13 residential care
  • 2 escalation of supported living

The service has built upon these positive initial results, and the latest evaluation shows that residential care admissions have been reduced by 18% (or equivalent to 57 people) in 2011/12. Total net savings achieved are £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.

In 2012, following the proven success of the telecare project, the Council took the decision to extend the service, and sought a partner who could offer telecare solutions and monitoring as part of a large-scale service. The provider was successful in this bid because of its track record of providing a solution which delivers all aspects of a successful telecare programme. From 2013 the service has been known as Safe and Well, and its preventative/early intervention approaches, in conjunction with telecare, produced a reduction in 2013/14 of £1.2 million (direct budget costs). The Safe and Well service was recognised as ‘inspirational’ and ‘person-centred’ at the Local Government Chronicle’s 2015 awards, where it won the Service Delivery Model category

Moorgate Mill has proven not only that it is a more financially viable model (it is envisaged that the scheme will save around 20% on care and support costs over time) but that it is possible to provide a more empowering environment for people with complex needs.

Future plans

Blackburn with Darwen is still developing ideas for the future and looking at the mix of proactive preventative services, coupled with empowering and re-abling for those with greater need. The use of complex telecare packages is increasing as part of a change program, and which shows that complexity of need is growing all the time. The Council is examining how the use of technology could be increased to support people with mental health needs, and exploring better options for dementia care with advanced technology as part of new purpose built extra care facilities.

More schemes like Moorgate Mill are being planned for young adults with autism and as part of the likely outcome of a review of the 32 existing supported living schemes in Blackburn with Darwen, where some properties may well no longer be fit for purpose in the medium to long term.

The Council has also developed a private pay telecare service, offering a ‘try before you buy’ scheme to encourage people who aren’t eligible for social care to pay for the service themselves.

 

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Demand Management – Assisted Living Leeds

What challenge did Leeds City Council face?

Leeds City Council was providing a wide range of good quality AT services but that these were, for the most part, operating independently and were not coordinated to provide disabled adults/older people, others with long term conditions and disabled children, with an integrated, complete package of technology which was embedded in their overall support plan.

Assisted Living Leeds (ALL) provides a truly pioneering new approach for Technology Enabled Care (TEC) and support. The centre provides a wide range of joined up services to support people with physical, learning and care needs.

What would have happened if a new model of care wasn’t found?

Services may not have been able to cope with the projected increase in demand.

There is an increasing number of people living longer with a disability or long-term health conditions and these people will require some element of ongoing care and support. There has also been an increase in the numbers of children and young people with physical disabilities and complex health care needs, surviving birth due to improved technology. Despite this increase, the method by which these people will be supported is undergoing a period of transition. There has been a decrease in demand for residential care homes for older people and this is coupled with a planned increase in community based support and Extra Care Housing. ALL will maintain an awareness of other service areas both within the Council and in the private and community sector to ensure the role of AT is considered in the care and support planning process.

How did you go about changing the model of care?

Funding of £2.17m for Phase 1 of ALL was approved by Leeds City Council’s Executive Board in spring 2013 to renovate the old Leeds College of Building site in the Leeds Dock area of the city. Construction work began in January 2014 and included refurbishment of the east side of the building and warehouse space to provide new facilities to host the Leeds Community Equipment Service, Telecare Service, Independent Mobility Assessment Team (Blue Badge Assessments), associated AT training and a newly developed Single Point of Information service. The refurbishment provides a physical space that allows for joining up of services and makes possible the coordination and promotion of (TEC) across all stakeholders who access AT services in Leeds. The new service opened in October 2014.

Services operating from the building have kept their own names and identities, but work together under the Assisted Living Leeds umbrella to give people in Leeds a more joined up service.

What process did you follow?

Service users, carers and a wide range of private sector partners were involved in the development of the proposals for Phase 1 and 2. A number of workshops were held with stakeholders to develop an approach, visioning the desired outcomes.

Difficulties faced

On Boxing Day 2015 the ALL centre was badly flooded, causing significant damage and resulting in some services being temporarily relocated. Months of hard work from the dedicated staff was necessary to resume business as usual.

The best thing about changing the model of care

ALL is one-stop centre so that people with physical, learning and care needs, and their families could have one place to go to get an idea of what type of equipment and other ‘assistive technology’ is available to support them in Leeds. People can make contact by phone or email or visit to find out about all the different types of equipment adaptations and other technology that they can use to help them at home. They are currently working with a Third Sector partner to develop a dedicated space for people to try equipment and staff from health and social care are trained on the use of equipment at the building.

What did you end up doing – components of the model

Assisted Living Leeds is a new centre that brings together a number of assistive technology services under one roof for the first time.  Phase 1 currently hosts the Leeds Community Equipment Service, Telecare, Blue Badge Assessment and in the future a Single Point of Information.

Who are the stakeholders involved?

The cost of the Phase 1 refurbishment was covered by a Department of Health Community Capacity Grant, allocated to the project by the Leeds City Council’s executive board.

Partnership working is a key element of both Phases, including:

  • Adults & Children’s Social Care and LCH providers
  • ASC, Children’s and CCG Commissioners
  • NHS
  • Third Sector
  • Universities (Leeds and Leeds Beckett)
  • Private Sector ‘tech’ Companies
  • Service User Group – ‘FHITE’

What and how is technology supporting you?

The Telecare service supports 16,000 people, 24 hours a day, 365 days a year, using a range of equipment to alert the response centre if a sensor detects any problems. The service receives some 30,000 calls each month with 97% of all calls being answered within 60 seconds. There is a target of 180 new installations of second generation telecare a month, which is being achieved, in order to reduce demand on community care budgets by £500,000. Additionally in the first two quarters of 14/15 699 new people were provided with pendant alarms, 64% of which were from self- referrals. Actions arising from calls received in Quarter 1-2 in 2015 included 1,346 requests for an ambulance, 214 calls for a GP, 746 calls to the fire service, 315 calls to the police,1,382 mobile response requests and on 6,747 occasions a key holder(family member or friend) was called. It is estimated that each second generation tele care installation saves an average annual sum of £2,330 on the overall cost of care.

What are the main benefits being achieved?

By locating these services together in a custom designed building we hope to achieve our mission to contribute to Better Lives for the people of Leeds by:

  • Providing universal information and guidance
  • Developing more personalised services
  • Providing service users with more choice and control
  • Delivering more early interventions and preventions
  • Strengthening partnership working between services
  • Co-ordinating the public and private offer
  • Improving service productivity, quality, innovation and value for money

Evidence / outcomes

The Key Performance Indicators include:

  • Increase proportion of people who use services who have control over their own lives.
  • Increase proportion of people using social care who self-direct their own support.
  • Reduce permanent admission to residential and nursing care homes (18-64 and 65+
  • Increase proportion of older people (65 and over) who were still at home 91 days after discharge from hospital into reablement / rehabilitation services.
  • Increase proportion of older people offered reablement service following hospital discharge.

Future plans

Following the successful delivery of Phase 1 of ALL, attention is now focussing on the potential to deliver Phase 2 of the project. Phase 2 proposals include developing a smart house, retail unit, dementia product and design space, ALL INN innovation lab, café, office space, assessment space, proactive telecare.

It is the intention that Phase 2 of ALL will enable the Leeds health and social care community to act in new and enterprising ways by engaging with the private sector, alongside the statutory and Third sectors, creating innovative partnerships aimed at further improving the services on offer to service users and carers. Early work on the ALL INN innovation lab has shown the real potential of this approach.

The objectives of Phase 2 are to:

  • Encourage people requiring care and support and their families to maintain their independence and well- being and plan for the impact of any health issues by seeing and trying AT products in a home environment.
  • Future proofing people’s lives by providing an environment in which they can see what adjustments to their home and provision of AT products will be beneficial as they age and they experience any progression in health conditions.
  • Create opportunities for people to make a choice about the AT products they use through a trusted retailer who can signpost to statutory services if necessary.
  • Further enhance the Council’s provision of a one stop shop for Assistive Technology living. Provision of a place where people will be assessed, be able to access information, see AT products in use and see up to date products.
  • Engage service users and make them feel a part of the development of new AT products which will help them lead more independent lives.
  • To increase the efficiency of the delivery of care services and in doing so reduce the overall cost.

Work is also progressing to pilot a Pro-active telecare service at ALL as an enhancement of the existing telecare service.

 

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Learning Disabilities – Gloucestershire County Council

 

What challenge did Gloucestershire County Council face?

Recent years have seen significant cuts to social care budgets, and this, coupled with rising demand for services, means that Councils have had to examine different ways of delivering care and support to people with learning disabilities. At an individual level, it can be a challenge to find the right balance between ensuring safety and enabling independence.

What would have happened if a new model of care wasn’t found?

Increasing levels of demand could have led to people with learning disabilities not receiving the highest possible level of service, and ultimately a lower quality of life.

How did you go about changing the model of care?

In 2011 Gloucestershire County Council commissioned an assistive technology pilot in 3 properties at 137 Stroud Road Gloucester, in order to assess the benefits in promoting the independence of the 11 tenants living there. A second aim of the pilot was to replace ‘paid for’ night support with a system that would enable independence to be developed and maintained without staff on site 24/7, through installing assistive technology.

A joint working group was set up with representatives from Gloucestershire County Council Learning Disabilities Team, the technology supplier, homecare provider and other relevant stakeholders. Timeframes and outcomes were agreed for the pilot project.

What process did you follow?                                                   

In order to establish the best solution for the required outcome the survey was carried out to determine risks associated with the property, staff and individuals living within each property. In A joint visit was undertaken with the technology supplier and the home care provider in order to assess the environment together with the needs of each individual to ensure that the proposed approach would be personalised for each of their needs which linked into their support plan and aspirations.

This proved valuable, as a joint approach considering technology and social care needs ensured the outcomes for each individual were considered and that the system when in place would achieve the desired outcomes whilst being person centred. The initial visit involved working closely with the Registered Manager at Stroud Road which was key to ensure that the staff team were on board and understood the process.

Difficulties faced

On the Stroud Road project it proved difficult to train staff who worked only nights within the agreed timeframe. In addition some training had to be re scheduled due to day to day management of the scheme and this not being convenient. Additional time would need to be considered and allowed for in future projects.

Individuals and the circle of care around them (e.g. family members, friends and carers) are not always aware of the types of technology available and how they can be used. Until they find out more and even see the solutions in practice many are cynical about the potential benefits. Earlier meetings with staff would have ensured they were more engaged and would have provided them with more time to understand the purpose of the equipment, ensuring that they would have used the equipment earlier in the project.

The best thing about changing the model of care

Achieving the ‘win-win’ of improved independence and quality of life for the people we support as well as making efficient use of resources.

What did you end up doing – components of the model

Site risks were identified and grouped into the following categories:

  • Communal risks – Fire, Carbon Monoxide, Door exit
  • Staff risks – Panic alarm/assistance
  • Tenant risks – Epilepsy, Bed exit, door exit, falls

Initial costs were:

Item

Cost (incl VAT)

Assessments

£660.00

Data Analysis

£240.00

Sockets and Fire panel work

£343.50

Telecare equipment

£6,990.81

Project Management

£1,170.00

Total

£9,404.31

 

 

Staff training was required and on-going support was provided by the technology supplier. Training sessions on the equipment was undertaken in 2/3 hours blocks which were delivered over 4 sessions so that the individuals were still supported appropriately throughout the process. Information on the use of the equipment was installed in the property which acts as reminders about what equipment is installed and how it is to be used.

Who are the stakeholders involved?

For the Stroud Road project, Gloucestershire County Council, the technology supplier and home care provider worked together, along with tenants, staff and landlord of the properties, plus the circle of care for each tenant.

What and how is technology supporting you?

Stroud Road - Property A

This property was identified as a priority to remove the waking night provision as the individuals were identified as having relatively low level needs and independent. It was agreed therefore to focus on this property as a priority.

Service User 1

We identified that this individual verbally communicated in short sentences, experienced no sleeping problems and in discussion with the manager no assistive technology would benefit the needs of this individual.

Service User 2

This individual would often get up during the night but may stay in her room however, sometimes uses the bathroom which is adjoining her room, where she has a history of turning taps on and causing floods. The initial recommendation was to install a Door Contact Sensor to alert if this individual has gone out of the bedroom and or is using the bathroom. A flood detector was also recommended to alert of any signs of flooding should she turn the taps on. It was also noted that a bed sensor be installed at some point in the future however this was not identified as a priority initially.

Service user 3

This individual experienced no problems at night and had regular sleep patterns

We discussed installation sensors on the front and back door as an alternative to the current chain in place high on the front door which is currently used to prevent individuals from going out. This would ensure greater freedom for the tenants to move around their home independently.

Recommendation:

Removal of the waking night within this property with a target timescale to be achieved through a phased approach once all equipment installed and staff training completed, this was monitored over a 4 week period to ensure that the equipment was working correctly prior to the waking night provision being removed

Property B

Prior to completing initial assessment of this property, there was originally no intention of reducing any support provision, however it was identified during the assessment that there could be a possibility of monitoring the waking night provision over a 2 – 3 month period, to enable us to identify the benefits of reducing to a sleep in provision.

Service User 1

The manager confirmed that this individual had irregular sleep patterns together with epilepsy and although well controlled there appeared to be no record of seizures over the last year. An epilepsy sensor was suggested to monitor this. Staff are required for certain periods throughout the night and we believed that assistive technology could monitor this activity in more detail and also give a better understanding of what provision is required during the night.

Service User 2

This individual is Diabetic and has no hypos/low blood sugar levels, and does not get up during the night, although experiences night time incontinence.

Service User 3

No problems at night no history of getting out of bed.

Service User 4

This individual can have severe epilepsy at any time, however this appears to under control and has no problems at night. Epilepsy sensor for the bed was recommended to alert if they had a seizure.

Recommendation:

It was identified that this could move from a waking night to a sleeping night with the right planning and training and installation of the relevant technology. It was agreed that this would take place approximately 6 weeks after installation once downloads had been analysed.

Property C

It was agreed that although property C would benefit from the installation of assistive technology at present due to the individuals needs it would not be possible to reduce any of the current support in place.

 

Evidence / outcomes – org, commissioning, people, staff – interviews

Property A

Within Property A the waking night was removed after 4 weeks of completion of installation. Savings achieved by removing the waking night @ £839.79 per week @ 39 weeks (July 2011 – March 2012) = £32,751.81

Property B

Savings achieved through reducing waking night to Sleeping night = £559.79 per week @

22 weeks = £12,315.38 (Nov 2011 – March 2012)

13 weeks = £7,277.27 (Jan 2012 – March 2012)

As the waking night is in the process of being reduced to a sleep night in Property B the overall savings for both properties are illustrated below:

1st Jan 2012

*2011/12 is based on Jan 12’ for Implementation of Property B & includes start-up costs of £9404

2012 onwards includes annual maintenance charge of £600inc VAT.

Total Annual Savings Year 1

£35,663 (Property B implementation in Nov)

£30,625 (Property B implementation in Jan)

2012 and 2013 realised further savings as the set up costs were allocated into year 1. Total savings for Year 2 onwards of £72,178 p.a. (which also accounts for the ongoing maintenance of the Telecare equipment at £500 + Vat per annum).

Future plans

Gloucestershire County Council’s Specialist Telecare Team continues to work with other stakeholders such as the Council’s Learning Disabilities Support Team to use technology to enhance care, increase cost effectiveness and enable independence for people with learning disabilities.

Including telecare as part of care packages has enabled many individuals with learning disabilities in Gloucestershire to become more independent and manage aspects of their daily routines without the need for support. Some recent examples are below:

Liam

Liam lives in supported housing with a small number of other residents and has been diagnosed with epilepsy. He is in his early twenties and enjoys activities during the day and interacting with staff and residents alike. Liam is able to communicate well, however his seizures were starting to increase during the night when he was not able to call for help. He was therefore unable to alert staff that he had had a seizure and access any help he needed.

An epilepsy sensor was installed that picks up the distinct body movements which indicate a seizure. If a seizure is detected, an alert is raised on a pager and vibrating pillow pad for sleeping night staff, and also to the Monitoring Centre in the unlikely event of carers being unable to respond. Liam was also provided with a discreet fall detector so if he should have a seizure during the day and fall to the floor, the alarm would be similarly raised.

Having the equipment in place made Liam feel confident in “getting the help needed” in response to an emergency situation and Liam can continue to live independently as normal. The sensor also enabled Liam to be monitored by sleeping rather than waking staff at night, saving £60.30 each night, which equates to a saving of £21,949.20 per year across the people sharing that night time support.

Tracy

Tracy has a mild learning disability and difficulties with her short term memory. She lives in sheltered accommodation, with carers onsite to assist if needed. However, Tracy is keen to maintain her independence as far as possible and complete daily tasks herself.

Previously, Tracy has had assistance from carers to manage her medication as she had some difficulties using the blister pack, such as getting the tablets out the compartments. On a number of occasions she had accidentally taken too many doses of her medication.

Tracy has been provided with a medication dispenser which has a small flashing light and beeps to alert her that it is time to take her medication. The dispenser holds all the medication in compartments so it will only dispense the correct dosage at the set time intervals, ensuring that Tracy does not take too many tablets by mistake. The dispenser is linked to the Monitoring Centre via a home unit, so after a set amount of time if the tablets have not been taken the Monitoring Centre will be alerted and will contact a Responder to advise them of the situation.

The equipment has enabled Tracy to become more independent in managing her medication, reducing the amount of support her carers need to provide. The dispenser has also made her safer at home due to the lower risk of overdosing. Tracy says that she is very happy with her equipment, and “would not be without it”.#

 

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Connected Care - creating sustainable telecare services

“We need to give the best support possible in the most effective way, and we are in the process of improving the embedding of telecare into pathways.  This helps us to give our service users 24 hour reassurance at the same time as being financially sustainable. It has also helped to improve information flow between health and social care, enhancing the patient experience and giving professionals additional information to support decision making.”

Sue Tivey, Senior Contracts Officer, Directorate of Care, Wellbeing and Education, West Sussex County Council

The challenge

As the UK population ages, pressure on hospitals is increasing with rising A&E attendance and growing numbers of delayed transfers of care.

How can technology help to underpin integrated working between health and social care, and keep older people independent at home and out of hospital?

 

What we did

West Sussex County Council and NHS West Sussex provide a telecare service which is provided free for 13 weeks for eligible service users. Over a 5 year period the telecare service has supported 15,000 residents to become telecare users.

The service is jointly funded by health and social care, and referrals for the free service must be received from a doctor, health professional or care professional. Users can also be assessed by staff from the service provider, who will install the most appropriate telecare equipment depending upon the individual’s needs. Most users (80%) will receive a Lifeline home unit and pendant, but some will also have additional sensors such as a falls detector, bed/chair occupancy sensor, temperature extreme sensor or smoke, gas or carbon monoxide detectors, depending on their needs.

The service aims to enable timely discharge from hospital, avoid hospital admissions, reduce domiciliary care or delay admission to a residential care home and referrals are accepted on this basis. Those who have benefitted include:

  • People with a history of falls
  • People with dementia
  • People recently discharged from hospital
  • Carers
  • Older people living alone
  • People with long term health conditions

At the end of the 13 week period, service users can choose whether to have the sensors removed, or continue with the service as a private customer.

Results

West Sussex County Council and NHS West Sussex have worked with the service provider to develop a seamless assessment, referral and rapid response delivery framework, helping to reduce pressure on health and social care services. Training programmes, assessment and care planning methodologies are integrated into care pathways, helping to mainstream the service and make telecare an integral part of health and care delivery across West Sussex.

Introducing this model has led to significant on-going growth in the number of private pay telecare users in West Sussex. At the end of the 13 week funded period approximately 70% of people choose to continue with the telecare service, funding it themselves. There are currently around 4300 self-funding users. This model ensures that people with long-term care needs are safeguarded, and at the same time it reduces the cost to health and social care.

The service reassures professionals that patients can be discharged safely from hospital, and risks to their health managed appropriately at home on an ongoing basis.

Service user satisfaction and outcomes are monitored on a monthly basis and feedback and results are overwhelmingly positive.

 

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Demand Management – Hampshire County Council

 

 

Starting from first principles, what would be the markers of a successful end to end managed service where TEC was part of business as usual? How does the industry have to change its offer to realise this and what will make commissioners sit up and take notice?

Mark Allen, Strategic Commissioning Manager, Adult Services, Hampshire County Council

This case study is based on the experience of developing and implementing a transformational Telecare/TECS programme within and across a large local authority area, Hampshire County Council and is addressed in that context.

The insights and views presented are those which have been derived from a number of experiences, observations or areas of activity spread over the last five years. This constitutes a perspective on the principle issues or markers that we consider to be important when considering, designing, implementing and then managing an end to end service, in our case base on a partnership with shared responsibilities. These insights and views are broadly derived from;

  • Managing a traditionally based diverse and outsourced telecare service that was largely focused on non-statutory service delivery.
  • Observing and understanding the landscape within which Hampshire were delivering these services, recognising the general and limited rationale for them at the time and from this a more extended understanding of the picture which existed and still does nationally. This is particularly in relation to evidence of achieved outcomes especially improved service user independence and financial benefits realisation.
  • Developing, with our current partners, an end to end outcomes based TEC service with a focus on delivering TECS as a core enabler of integrated adult social care and health delivery,
  • Establishing outcomes as the primary driver for development and regarding the ethical and regulatory framework around social care services as the benchmark for our expectations

Hampshire, like many authorities, based its initial approach to telecare on what we would argue are two fronts, an established model that grew out of the housing sector and that had somehow grown into a ‘preventative’ model where ‘scale’ was a principle driving force and one that essentially had the technology at its core, where ‘kit’ provided a solution to be applied, something like a plaster. This was something of the norm at the time (circa 2008-12), an approach adopted by many authorities. This latter point is an important one to note and an approach that we would argue, with hindsight, is possibly the antithesis to an outcomes based approach to delivering social care services which is personalisation focused as opposed to property focused.

It would be true to say that a significant amount of effort has been dedicated to growing the usage of or mainstreaming telecare, telehealth and latterly TEC services over recent years. It would be equally fair to state that the impact of this growth and mainstreaming activity on the social care and health economies has not been what it could be. Some may argue otherwise but whilst the use of telecare is now ubiquitous the evidence that it delivers anything beyond large numbers and ‘comforting’ generic outcomes is limited, certainly in an area of our greatest challenge, delivering services to our most vulnerable older residents and improving independence for younger adults with complex needs. Given the financial challenges post 2008 and the demographic pressures that continue to emerge it is very surprising that the social care sector is still searching for meaningful answers in relation to quantitatively evidenced benefits of the application of telecare or TECS.

 

What’s going on and have we missed the point?

Our view is that, in the arena of social care at least, the strong focus to date on technical development, on products that deliver a defined solution or delivering ‘technology’ at scale may have in fact contributed to the limitation of any potential impacts rather than opened up social care services and practice to the very real possibility that technology and TECS have a long-term and definable place in how we offer, manage and deliver services to vulnerable people.

It’s also worth asking the question, does a continued focus on the product itself (or catalogue of products) further serve to take us away from the need to integrate developments in technology into the working lives of practitioners and the lived experience of customers and clients which are framed in and by that experience? It is interesting that in many places telecare, telehealth or even TECS are delivered as compartmentalised service areas, somewhat mirroring the Tech industry itself.

This is often combined with expectations around impacts that are coupled with a preoccupation with either numbers (connections in many cases), specific products or product types, % of calls answered rather than quality of answer, a focus on change around ‘low hanging fruit’ and/or preventative interventions where outcomes and therefore impacts are difficult if not impossible to measure. In each of these circumstances there is often a deficit on the incentive for Commissioners or Senior Managers within Social Care or Health to invest long-term in TECS as a serious contributor to the very real and present challenge facing how we deliver a complete and efficient social care and health service. Our challenge is to effectively integrate TECS within our broader systems and address some of the deficits outlined above.

The ‘Mainstreaming Telecare in Hampshire’ project has been an example of an attempt to do just this. To integrate TECS into social care practice in such a way as to effectively deliver impacts that are intrinsically linked to the personal, systemic and regulatory outcomes at low or no cost demanded by a system under pressure and one that also and critically needs to deliver diverse services to vulnerable people in order to meet their needs.

The first line of the question this paper is attempting to address is ‘Starting from first principles, what would be the markers of a successful end to end managed service where TECS was part of business as usual?’ The first principles to address are those issues outlined above, for example, a successful marker will not be numbers first but rather outcomes and how these impact for individuals, organisations and the social care landscape. Only then, can we count the numbers and then argue we can begin to meet the unique challenges each of our authority areas or set of circumstances presents.

 

So what is our approach and what can we share that may be of use?

Hampshire entered into a partnership in 2013 to deliver an end to end TECs service. Key was that it would be a transformational project for which our partner would take responsibility and it would;

  • Embed telecare and latterly TECS into social-work practice (to the point where it is a primary element in those services that can be deployed to meet an individual’s needs)
  • Bring specialist expertise to enable the authority to solidify its strategic direction and objectives
  • Embed the project into the wider social care and health landscape to facilitate a more complete TECS response to individual, systemic and regulatory requirements – essentially as stated above, making it part of social care
  • Integrate with the AS Department and take on a joint management function, delivering specialist input and contributing to strategic and operational decision making
  • Move our service response from deploying ‘kit’ that has a pre-defined purpose to one where the identified risks and associated outcomes that service users need addressing and require are the principle drivers then meeting organisational or systemic outcomes
  • Within the above, move our response (operationally around TECS but also and critically within assessment and support planning) to one where TEC is deployed to reduce the requirement for if not eliminate completely the need for traditional social care services
  • Develop effective benefit measurement systems, measuring individual outcomes as well as specific financial benefits from the approach
  • Share the benefits realisation gains widely to demonstrate both efficacy and efficiency for individuals and for the system within which we operate

Our view is that these elements constitute the key markers for a successful end to end TEC service within the social care sector.

We have just crossed the threshold of three years of service delivery through the partnership. A fair challenge to us at this time would be, what have you delivered, how effective has this approach actually been (you talk about outcomes but where’s the evidence?) and what lessons have you learned and what tips can you pass on?

 

Some simple facts:

  • 6000+ clients Significantly above target and representing almost 50% of non-residential client cohort)
  • £4M net savings to date (Year 2)
  • Over 1000 referrers e.g. social workers & occupational therapists trained and certified
  • We receive over 100 social care referrals a week
  • 9 out of 10 social workers say telecare is “good” or “very good” at achieving desired user outcomes
  • Social workers regard the service as part of the ‘blended’ range of non-residential care services
  • 95% of users surveyed feel that telecare has increased their feelings of safety and security
  • 98% of users surveyed would recommend service to others

 

A straightforward story:

Mr SB has dementia, and has recently begun walking about and getting lost. He is a smoker, habitually leaving lit cigarettes around the home, which has led to a number of small fires.

Telecare Solution:

Mr SB’s telecare comprised a carer pager, a wrist pendant alarm, a door exit sensor, monitored gas and smoke detectors, and a home unit. The telecare solutions supplement an existing care package, avoiding the need to increase the level of care further during periods when the primary carers are not in the home.

Results:

This service enables the primary carer who supports Mr SB to continue in full-time work. Mr SB is maintaining his independence and the solution has delayed his admission to residential care. His carer’s risk of breakdown (due to constant vigilance and high anxiety levels) has also been reduced. This deployment has led to net savings of £1,500 per month to Hampshire County Council.

 

Our lessons

Clearly, benefits realisation is a central plank of our approach. Adult Service Departments are data rich environments, offering the opportunity to cross reference input from Social Workers, historical trends from existing data, trends in changes to services delivered and live data from service providers and customers. Such a mix has enabled us to demonstrate significant individual, cohort and service outcomes and efficiencies. It has also proved critical in enabling Senior Management buy in, establishing a long term and positive relationship with Social Workers and critically, proving the value and efficacy of our change programme.

Procurement and commissioning: in order to establish the right framework to deliver the requirements of our concept of an end to end service model it is important that any commissioning and subsequent procurement activity does not proceed on a purely transactional basis. As such selection criteria are developed that enable authorities to take a competency based approach; prioritising demonstrable competency for delivering our broader service requirement rather than the capability to simply deliver, install and manage x or y numbers of kit. Broader expectations for both selection and delivery underpin the outcome based approach detailed above and form the foundation for joint ownership of both performance and outcomes delivery.

Senior level buy in is key, certainly in the initial stages. Establishing an embedded end to end service is challenging (challenging to existing practice and management approaches). Key management understanding of the approach, the potential challenges and changes to be confronted (e.g. workforce behavioural change or that TECS can be part a first line part of social care services) and acceptance that outcomes are the driving principle all require strong leadership and commitment. Strong relationship management principles also play a significant role in implementing and maintaining meaningful service development of this sort as does a commitment to joint management.

A final but important lesson for those wishing to deliver TECS under the social care umbrella is the primacy and relevance of statutory regulatory frameworks. For an industry that has for many years self-regulated, the impact of entering this area of work with a serious intent can be significant.

Do all providers understand what being a ‘grade A’ front line social care service means?

 

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