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A Sustainable Approach to

Telehealthcare in Tameside

and Glossop

Christine Craig

Service Unit Manager

Tameside Borough Council

19th May 2015

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Tameside Specific Health/Social Care

• The cost to the health economy in the UK is

currently under immense pressure

• What this means for Tameside

• Hospital in crisis

• Drivers for change:

- The Care Act 2015

- Integration/Care Together

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Population - Tameside

• Tameside population

• Tameside is made up of 9

towns

• Tameside’s Health

• Council’s drivers for change

• Telehealth wellbeing

Tameside Statistics

Population 216,731 People aged 0-15 42,364 19.55%

People aged 16-29 39,189 18.08%

People aged 30-44 44,460 20.51%

People aged 45-64 56548 26.09%

People aged 65 and over 34,170 15.77%

Average life expectancy (Male) 75.97341

Average life expectancy (Female) 80.97166

Size of area in km2 103.1685

Size of area in sq mi 39.82112

Population per km2 2100.748

Population per sq mi 5442.614

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How can Telehealth help?

Timely, Accurate and Targeted Health Information

• More frequent & regular information gathered

• Vital sign observations

• Health questionnaires

• Targeted self care advice given

• Patient feels daily engagement with their care

Timely & Appropriate Care

• Identifying trends allows early intervention to prevent

exacerbations

• Maintain Patient in a low cost setting whilst improving care

• Prevent Patient presenting in practice in advanced condition

• Support better medication prescription & compliance

• Easily gauge the impact of medication change

Cost Savings

• Saving in reduction for non elective admissions

• Shift to less costly interventions (e.g. telephone

consultation, nurse visit self care intervention instead of

GP, A&E attendance

• More effective medication prescription

Improved Quality of Life

• Patient feels more in control

• Patient and or Carer may feel less

anxiety

• Patient remains at home for longer

Better Self Management

• Patient has increased awareness

& engagement of their condition

• Greater likelihood of lifestyle

changes being adopted

Improved Health for the Patient

Conditions stabilised, better health & less

likelihood of exacerbations

Fewer Unplanned Interventions

Reduction in A&E visits and hospitalisations

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Telehealth

The Telehealth function is commissioned by Tameside & Glossop

CCG and this service provides equipment fitting and advice

services, technical triage and monitoring, and the provision of 24

hour help and advice. Medical interventions are provided by the

NHS. The focus of this service is to provide medical screening in

the patient’s home, and reduces the frequency of visits to the GP

and hospital.

Telehealth is a service to support patients with long term

conditions (CHF and/or COPD) in Tameside and Glossop. The

service uses Telehealth monitoring appliances to transmit daily

information about a patient’s condition, including weight, blood

pressure, oxygen levels and temperature. Responsible clinicians

will monitor this information and provide immediate support where

necessary. Telehealth enables individuals to manage their long

term condition effectively at home, reduce exacerbations, and

can result in an early diagnosis of unforeseen health related

problems, as well as empowering patients to take a more active

role in their care. It is envisaged that this service will help to

reduce unnecessary A&E attendances, hospital admissions,

outpatient attendances and length of stay in hospital.

Here at the Community Response Service, we currently

technically triage 265 Telehealth units/patients. The MyMedics

installed are split between patients with CHF, and/or COPD.

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Telehealth Concept

Secure N3 IT &

Communications

Network

Triage & Clinical Monitoring

Telehealth ‘MyMedic’

Patient feedback

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Infrastructure for Managing Mainstream

Telehealth Services

Prioritised & appropriate clinical intervention: phone

consultation, self-care advice, home visits, GP appointments

etc.

Clinical assessment of

validated data

Technical triage validation

of all data

Patient data accessed via

web-based triage software

Identifiable data hosted in

N3-environment

Anonymised data

transmitted via secure

telephone

Daily data collection: vital

signs and health question

responses

Patient trained and

equipment installed by on-

site visit

Community Response

installation visit scheduled

Community Response

Patient enrolled via online

web portal

Patient referred for

Telehealth Service

Tameside Council Managed Service

NHS Tameside & Glossop

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The ‘MyMedic’ supports multiple languages, vital signs,

devices and condition specific health interviews

User Interface

• Text and audio

• Vocal prompts can be recorded locally

• Language & dialects supported

• Large graphic colour display

• Variable text size

• Pictures

Information Exchange

• Condition specific health questions &

‘branching’

• Reminders

• Self-care and advice

• Medication prompts

• Repeats readings to Patient

Medical Device Readings

• Blood Glucose

• Blood Pressure

• Weight

• Pulse

• Oxygen Saturation

• INR

• Temperature

• Peak Flow

• ECG

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MyClinic supporting multiple Patients in one location.

E.g. Residential Care Home, GP Practice

• Proposals for the future

• Group Homes/Extra Care Housing

• Residential and Nursing Care

• GP Surgeries

• Pharmacies

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Telehealth Pilot

• Approval was given by PCT to pilot 60 Patents in October 2011

• Aim by March 2012 was for a further 145 Patients

• Currently monitoring 265 Patients

Evaluation of Pilot

• Emergency admissions reduced by

35%• A&E attendances reduced by 40%

• Outpatient attendances reduced by

20%

• Length of stay reduced by 70%

Patient Evaluation

• Improved self-management of their condition

• 83% of Patients reported improved quality of life

• 95% said the information given was easy to

understand

• 88% said equipment was easy to use

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Present Times Versus Future Outlook

Present

• People aged 60yrs plus account for 55% of the NHS budget

• Of people in community hospitals, 40%

could be supported & cared for at home

• There are 30% of older people in

residential homes that are

inappropriately placed

• Accident rates for older people continue

to increase

Future

• People are living longer without family

support• Over the next 50yrs, over 65’s are set to

double

• An increased need for community based

care/support

• Higher expectations• Want/need to remain independent, have

choices and maintain dignity

(Source Department of Health)

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Telehealthcare

Joanne Strothers

Telehealthcare Manager

Tameside Borough Council

19th May 2015

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Today’s Objectives

• To increase your knowledge of Telecare

• To equip you with the knowledge of how the Service and Equipment can

support individuals to remain at home

• To give you information to enable you to offer choices to individuals

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My Right to Choose

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Building Telecare

“Councils are expected to invest in

providing choices, health, and wellbeing

for a diverse range of Clients”

(Building Telecare in England DOH 2005)

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Telecare – The Facts

The Preventative Technology Grant

• There was an £80 million in grant finance over 2 years from

2006-2008

• Tameside’s share of this grant was £383,537

• Designed to help local authorities with Social Care

responsibilities, and their partners to address the

challenges of a changing and ageing society

• To support Service Users’ increasing independence,

expectations, control, choice and dignity within their own

lives

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Telecare – The Facts

The Aims

• To remain at home for longer with safety and security

• To reduce inappropriate admissions to Residential Care and Nursing

Care

• To encourage earlier/safer discharge from hospital to home

• To allow more personal freedom and reassurance for Carers

• To meet potential shortfalls in the workforce as complimentary care

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Telecare – The Facts

Getting the right balance

• Balance between the use of technology and continued human contact

• Care must be taken to ensure that technologies do not control or isolate people

• Some care services will always be delivered personally

• Human contact is imperative in maintaining quality of life

• Technologies will compliment traditional forms of care

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Tameside Community Response Service

Proud to be a Service• We operate 24 hours a day, 7 days a week,

365 days per year

• CRS is open to all ages

• We stretch our Service across Older

Peoples Services, Learning Disability

Services, Physical Disabilities, Mental

Health and Children’s Services

• We cover the whole of Tameside with a 20

minute response time

• We install our own equipment, carry out

reviews, equipment tests and property risk

assessments

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Tameside Community Response Service

Our Team

• We run the Service with 36 members of staff (3 Service Coordinators,

2 Operational Support Officers, 1 Modern Apprentice, 19 Community

Response Workers and 11 Emergency Control Operators)

• As a team we have over 367 years’ experience

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What is Telecare?

Telecare is an enhanced monitoring system that supports and

compliments a package of personalised care.

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Why are we providing Telecare in Tameside?

• To offer choice and flexibility of service provision from a standard Community

Alarm Service to an enhanced monitoring system

• A total of 90% of people say they want to live in their own homes

• As many as 35% of these could be supported in their own homes with Telecare

• Over 1.6 million emergency admissions were made in 2013/2014

• Telecare has the potential to reduce unnecessary admissions and improve the

quality of life

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Telecare is essential in unlocking the demands

in Tameside

• Not realistic to plan to deliver care & support services in the way we do

at present

• Services will take on new patterns of working to meet changing care &

support needs and user choices, moving towards reablement and away

from dependency

• Tameside’s Community Services have made a commitment to invest

technology

• To meet Government agenda’s and the increasing demographic trends

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Our Emergency Control Centre

• From April 2014 to March 31st 2015 the Emergency Control Centre handled

172,849 inbound calls from service user’s devices this could either be a care-

phone, pendent, smoke, wander alerts or other numerous devices. From the

inbound calls the community response workers physically attended 11,975

times in response to the activations from the equipment. We have 11

Emergency Control Operators who work 24hrs, 7 days a week, 365 days per

year.

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Our Response Service

We currently have 18 Community Response

Workers covering 24 hours a day, 7 days a week,

365 days per year

Last year, we physically responded to 11,975

activations of equipment by Service Users

20 Minute Response

• We aim to attend all calls that require a Warden

within 20 minutes

• Over the last year we arrived in less than 20

minutes to 90.2% of calls

Under 20 Minutes

Under 45 Minutes

Under 60 Minutes

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Call Breakdown

The Community Response Service attends a wide variety of calls across the

Tameside area. Our Wardens are fully equipped to deal with all types of calls, and

have the necessary equipment in place to be able to do so.

With the use of Camel and Elk cushions, the Wardens are able to assist up Clients

who have fallen. This reduces the number of Ambulance calls, and also reduces

the length of time the Client has to wait for assistance. Over the last year we have

attended 1976 calls for Clients that had fallen.

Faulty Equipment Activated in Error

Property Home Care Tasks

Toilet Fall

GP Fire

Ambulance Access to Property

Reassurance

Falls Statistics – UK

• 200 elderly or frail people fall

over every hour during the day

• 450 elderly or frail people fall

over every hour at night

• 20% are admitted to hospital

• 3% are seriously injured or die

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Our Partnership Working

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Access to the Service

Service User Methods;

Phone, Mail, EmailFamily/Friends/Carers Professionals

Referral

details taken

Contact, arrange date

and time to install

Visit/Inform/Install

Collect details,

risk

assessment

etc.

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Telecare Outcomes

Mrs B (78yrs), lives alone in private accommodation

• Diagnosed with Dementia 18 months ago (progressively worsening)

• Good family support• Prone to wandering during night time, leaving the gas cooker on etc.

• Family considering Residential Care

Telecare InterventionDoor Contacts, Smoke Detector and Gas Detector fitted

Actual savings since installation• £450.00 per week x 56 weeks = £25,200

• £5.90 per week x 56 weeks = £330.40

• Total savings £24,869

Mrs B remained in her own home living safely and independently

for 56 weeks

Smoke Detector

Gas Detector

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Our Clients

• The Community Response Service currently has

4072 Clients using our services

• Community Response provides services to

customers through an alarm

• A customer may have a ‘hardwired’ alarm or

community alarm installed in their home which

connects to the landline and the electric supply. At

March 2015, Community Response provided

services to 4072 living across the Tameside

Borough

• The current charge is £5.90 per week for a 24 hour

service. The cost includes a wide range of

Telecare devices installed to individual needs

which is, monitored and maintained by the service

18-64 65-74 75-84 85+

In December 2014 an exercise was

undertaken to evidence the number

of Service Users in receipt of CRS

and a package of care from Adult

Services. This equated to 27.6%

which indicates that of our Service

Users, 72.94% only have CRS.

38.2% have been diagnosed with

Dementia.

Of our 4072 Service Users:

11% are between 18-64yrs

19% are between 65-74yrs

36% are between 75-84yrs

34% are over the age of 85

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What our Customers have said

“Many thanks to you all for your quick responses and caring always. I had a weekend of

falls which I am so sorry for each fall was through my over- reaching; I am determined not

to do this again. I hope you all have a lovely summer I am so grateful.”

(Mrs Wilkin)

“Dear wonderful workers,

On behalf of my mum we both wish to thank you so very much for the fantastic support

and help you have given to us over the past years. On the occasions when response and

assistance was required the team has acted with care and thoughtfulness. My mum has

now moved into Residential Care therefore has no further need for your valued service”.

(L. Gilbert)

“To everyone at the Community Response Service,

Thank you for the excellent service you provided for my father. Sadly he has passed

away However; he was able to stay in his own home until a few days before he passed

away. Your prompt action when he activated his alarm meant the ambulance crew was

onsite promptly. The service gave us precious extra months that allowed us to support

Dad in his home.”

(J&P Houldridge)

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“What Telecare means to me” Mick Burkhill

I feel in one word that Telecare has given me my life back

Longer to live a near normal life for longer

Independent still live independently in the community

Fuller fuller life complete with more freedom

Existence exist in safety to live another day

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Takk for

oppmerksomheten!

joanne.strothers@tameside.gov.uk

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Learning Disability

ServicesAlison White

Service Unit Manager

Long Term Support

Tameside Borough Council

19th May 2015

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Assistive Technology

Learning Disability Services

Long term support

manages services to

81 adults with

learning disabilities

sharing properties in

the community

Services in the Community

• There is a cost implication to services in individual

houses in the community

• Staff 24 hours

• Sleep in every night

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New Services Developed

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• Enables services to run

without the same cost

to the service

• Consultation with

service users

Moving from houses to flats

Kevin Quirke – two years on Complex Service User’s who live at Carlton Springs

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Carlton Springs Budget

• Stamford Street is where 4 of the service users at Carlton lived independently.

• Hours for this property were 1352 hours.

• At Carlton we support another 12 service users for only an average extra 200 hours per month.

• This is continuing to reduce as shown on the graph we started by using 1950 and we are now down to 1550.

• We have also carried maternity of 120 hours per month taking this away we are managing on 1430

• S has 19 hours ILF, I has 14 hours ILF and M has 8 hours direct payment per week.

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Carlton spring reduction in hours over the last

8 months

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Services Developed - greater independence

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Services that include assistive technology

promote

• Greater independence

• My own home

• Saves money

• Gives control to the service user

• Reassurance to family and individual

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Tusen Takk

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