Andrew Copley Director Of Finance & IM&T ~ Airedale NHS FT

Care Anywherethe story so far…..

Telehealth, e health,digital health…..

Telecare Telecoaching Telemonitoring

Teleconsultation

tele medicine

Tele consultation/medicine

• 9th year• offender health• care in patient’s homes• nursing and residential care• end of life

24/7 clinical hub improving patient experience changing patient flow reducing costs

Our teleconsultation journey

Revolutionising ways of working

Scale and opportunity

138/248 homes

~4000/7867 residents

£78.9 million

 amount spent by LA for non-medical social welfare for 7867

7229 A&E attendances 

4765 hospital admissions 

Annually:

Can expansion of telemedicine keep more people out of care homes and hospitals and reduce this? Reduce costs whilst in care homes?

One A&E admission costs ±£2400.  Cost of making one care home tele-ready is same for one year

In our service area:

Current position

• 250 Nursing/Residential Care Homes+ 100 in implementation

• Supporting > 8000 residents

• Provide, safe, effective high standards of care • To support residents to stay at home

• Support residents/nurses/carers in the planning, and delivery of care

• Escalate to community teams out of hours

Aim of the service

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Care Homes – outcomesemergency admissions

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Care Homes – outcomesA&E visits

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Return on Investment• 27 Nursing/Residential Care Homes

CCG Contract PaymentsService charge £110,200Consultations £ 66,846Total Cost £177,046Impact on Contract IncomeNet impact on reduced £1.158MAdmissions Income Net Impact on A&E attendances £0.036M

Total net Income Saved £1.194MReturn on Investment £1.194M/£0.177M = 6.75Invest £1 and get £6.75 back

Further Benefits to be quantified across the whole health EconomyOpportunity for Reducing beds ~ Reduced admissions & improved LOSRe-invest Income reductions into different servicesDiagnostic/Hotel costsCommunity travel costsAmbulance Costs

Extension of the ServiceGold Line ~ Reducing further admissionsGP Triage ~ Freeing GP CapacityPotential for replacing out of hours GP services/or a mixed model reducing duplicationBetter co-ordination of workforce ~ Integrated Consultants using Teleconferencing

            Virtual MDT`sRedesigning Outpatients

Non Financial BenefitsImproved Patient CareSupports deliver of Quality and performance targets

• last year of life• help vulnerable patients to remain at home • improve experience – coordination of care across health settings.

• to increase the number of patients who die in their usual place of residence 

• reduce hospital bed days

Gold line

Gold line – early outcomesinternal analysis – AWC and Bradford CCGs

Patient Disposition after CallApr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar0

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200

300

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6002013-14 2014-15

Number of Calls

May2014

Apr2015

AWC CCG 275 451

Bradford CCGs

292 515

iPAD 21 30

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb050100150200250300350400450500

Patient remained in place of residence Admitted to Hospital Admitted to HospiceReferral to A & E Department Reported Death Ambulance Called To AssessOther

Caseload

Place of deathNational Data 2011England %

Bradford and Airedale PCT

GSF register/Gold Line 2013-14

Home 20.1% 20.3% 41%Hospice 5.2% 3% ** 23%Care home 17.8% 26.1% ** 22%

Hospital  54.5 % 48.2% 14%

Intermediate care hub

• launched November 2014• 24/7• referrals from health professionals• MDT approach to triage• aim to support people to remain at home• with bed based intermediate care if 24/7

enablement required• average 23 referrals per day

• Clinical assessment by Hub nurse

• Onward refer if required to HCP for home visit

• Request prescription

• GP surgery informed by NHS secure mail

Extension of Telemedicinein Nursing Homes

GP Triage ~ Taking All calls

GP visits - very early data

February 2014 February 2015Practice A – 27 (35) Practice A – 17 (56)

March 2014 March 2015Practice A – 30 (36) Practice A – 12 (36)Practice B – 41 Practice B – 26

(Requests)

GP Feedback

"Of all the changes in the 15 years I have been working this is the greatest change which has reduced workload I can remember. I don't mind the extra "late" duty doc visit as this is more than made up in the drop in other visits. A big thank you to all involved."

connecting primary & secondary care now

connecting whole health & social care economy tomorrow

Clinical history, medication, providers

shared integratedhealth record

Shared record

Registered practitioners

Visual contact

Success - sum of the parts

In Care Setting

Proven SuccessScaleAmbition

Enhanced Health

Using data to reducevariation & change clinical practice

Using Data to evaluate Clinical practice ~ Greater standardisation Reduce duplication & waste

Using Real Time data ~ Improve productivity Maintain standards

Improve clinical Outcomes Change clinical practice

Outcome Measures

Improve LOSReduce Drug prescribingReduce Pathology & Radiology RequestsTheatre Throughput

How Can Technology Drive Efficiencies

Electronic Patient RecordsE ObservationsOrder Communications

Reduce Medical Records workforce.Reduce AdministrationReview workforce & skill mix on wardsReduce waste and duplication on Tests and prescribing.Validation prompts to reduce errors and clinical risks

Integrated PAS between Primary Care & Secondary Care& Teleconferencing Technology

Redesign of OutpatientsDifferent Approach to making appointmentsVirtual MDT`sNetwork of Virtual Consultants providing flexible capacity.Better demand managment

Technology Enabled Health & Carethe art of the possible….

Questions?