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Appendix A 1 Assistive Technology Strategy 2015/16 Page 159 Agenda Item 10
Appendix A
1
Assistive Technology Strategy
2015/16
Page 159 Agenda Item 10
Appendix A
2
Contents
1. National Policy
2. The Vision
3. Definitions and Scope
4. The Local Position
5. Current Assistive Technology Provision
6. Feedback from Residents and Practitioners
7. How has Assistive Technology been used elsewhere
8. Issues
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1 National Policy1.1 Over the past decade Government policy has been to encourage care outside
of hospitals and care homes, by developing health and social care services within the community. This was included in the Health and Social Care Act 2012 and is being further developed in the Children and Families’ Act 2014 and the Care Act 2014.
1.2 The financial pressures facing public services for the foreseeable future make it crucial that initiatives to deliver care in innovative, integrated, coordinated and cost effective ways are pursued as a matter of urgency. The potential for assistive technology to manage the increased demand expected as a result of an aging population and legislative changes such as the Care Act 2014 were highlighted in the report ‘Ready for Ageing’ from the Lords Select Committee on Public Service and Demographic Change.
1.3 The Department of Health believes that at least three million people with long-term conditions and/or social care needs could benefit from telehealth and telecare by 2017, and is promoting these services through its 3 million lives (3ML) programme.
1.4 The Care Act 2014 introduces a statutory duty for local authorities to make sure that people who live in their area receive services that prevent their care needs from becoming more serious. Assistive technology can contribute to achieving this, in particular supporting the prevention duty in the Care Act 2014. This strategy provides several examples of how assistive technology can reduce or delay an individual’s needs for statutory social services.
1.5 As a result of the Prime Minister’s Dementia Challenge and Dementia Friendly Communities campaign, Alzheimer’s Society set up a task and finish group on dementia-friendly technology in October 2013. The main task of this group has been the production of a dementia-friendly technology charter which was published in June 2014. The overall aims of the charter are: To help every person with dementia have the opportunity to benefit from
technology appropriate to their needs. To outline and encourage the implementation of high-level principles and
best practice for organisations that provide services to people with dementia.
2 The Vision 2.1 The Vision that this strategy aims to achieve is to: significantly increase
awareness and broaden the use of technology so that people maintain their independence for as long as possible thereby reducing and/or delaying the need for statutory services.
3 Definitions and Scope
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3.1 The definition for assistive technology is one that was developed by the Foundation for Assistive Technology (FAST) in 2001 working with the sector and is as follows:
“Assistive Technology is any product or service designed to enable independence for disabled and older people.”
3.3 In line with this definition the scope of the assistive technology strategy includes daily living aid, telecare, telehealth and telecoaching (Appendix 2 provides examples of products and their uses). Specifically excluded are remote consultations with clinicians (Telemedicine), use of assistive technology in hospital settings and mobile working for staff.
4 The Local Position4.1 There were 191,123 people living in Sutton at the time of the 2011 census and
this is projected to rise to around 222,000 by 20211. The population is predicted to increase, not only in size through increasing birth rates and migration, but the population is also increasing in age.
4.2 The figures below show the expected percentage increase in population between 2011 and 2021 by age.
Age Expected % Increase in Population65+ 18.7%75+ 17.1%85+ 2.3%
4.3 Carers In the 2011 Census over 18,000 people in Sutton (9.6%) reported providing some level of unpaid care to family or friends.
4.4 Children (aged 0-19) with a Disability887 children were registered with Sutton’s Children’s Disability Database in July 2012; including learning disabilities, physical disabilities and communication difficulties.
4.5 People with Learning Disabilities Sutton’s profile of people with learning disabilities is unique compared to other parts of England, with older populations of people with learning disabilities than previously expected. In general as people with learning disabilities get older they will have increasingly complex health and social care needs.
4.6 People with Dementia
1 2011 Census
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Currently there are estimated to be 2,000 residents in Sutton living with dementia, with only 700 of these having a dementia diagnosis. Of these at least 150 with a primary need to dementia are currently supported by social services. The number of people living with dementia is expected to increase by 18% to 2,360 by 2021.
4.6.1 It is estimated that 63.5% of people with dementia live in the community, of whom two thirds are supported by carers and one third live alone. Approximately 36.5% live in care homes. The majority of residents in care homes for older people have a form of dementia.
4.7 People with Long Term Conditions The number of people aged over 65 years with a limiting long term illness is projected to rise from 11,570 in 2010 to 17,670 by 2030.
4.8 People at Risk of a FallThe consequences of falling can be minor, but with increased frailty and osteoporosis the consequences can be significant, resulting in a fractured neck of femur.
4.8.1 The rate of Hip fractures in people aged 65 and over is 486 per 100,000 in Sutton. . For over 80 year olds the rate is much higher (1,516 per 100,000).
5 Current Assistive Technology Provision5.1 Telecare provision
In 2013 a referral to response service was commissioned, bringing all the components of telecare provision and mobile response within a single contract. This service is run by Eldercare.
5.2 The service is for social services clients, people living in Sutton Housing Partnership sheltered housing schemes and is also available to residents to purchase themselves (self funders).
5.3 Eldercare ensure adult social services staff have an up to date knowledge of new technologies through regular training/awareness sessions. In addition Eldercare has recently opened a shop in Carshalton Beeches which includes equipment demonstration. This enables people to understand what is available, how it can assist and enables them to purchase the equipment (including support services such as call monitoring and mobile response as required).
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5.4 Current UsageAs at March 2014 293 people were receiving telecare as part of a social services package of care.
Service NumberBasic community alarm service + keyholders 91Basic community alarm service + Mobile Response 91Community Alarm + Telecare sensors + keyholders 36Community Alarm + Telecare sensors + Mobile Response 75Total 293
The table below shows the type of Telecare equipment in use for Social Services Clients in Sutton as at 31.3.2014.
Falls
Dete
ctor
Property
Exit Se
nsor
Smoke
Dete
ctor
Carbon M
onoxide Se
nsor
Bed Senso
r
Temperatu
re Extr
emes
Senso
rEpile
psy Se
nsor
Bogus c
aller/p
anic
Button
Flood D
etecto
r
Chair Se
nsor
Memo M
inder
Room Pull Cord
Trigge
rs
Heat Se
nsor
PIR Senso
r
Pressu
re M
at Se
nsor
0
10
20
30
40
50
60
70
80
Num
ber
5.5 In addition to the 293 Social Service clients a further 915 residents purchase telecare service themselves from different providers that provide telecare in Sutton.
Total
Number of Clients
Number of Clients with Mobile Response
Sutton Social Services clients 293 166Eldercare private clients in Sutton 565 89Age UK Aid Call private clients in Sutton 261 -Merton Mascot private clients in Sutton 51 24Mole Valley Telecare Services 38 -Total 1208 279
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5.6 Supported Housing EnvironmentsSheltered housing, extra care and supported housing schemes are built with a hard-wired emergency alarm system usually with pull cords in each room which allow residents to summon assistance in the event of an emergency. Communal door entry systems, individual smoke detectors within each flat and a fire alarm system covering communal areas may also be connected to the emergency alarm system.
5.7 There are in excess of 1,150 rented supported housing properties in Sutton with a hard-wired emergency alarm system. These are owned by LB Sutton and Registered Social Landlords. In addition there are a number of private, leasehold sheltered housing schemes which also have a hard-wired emergency alarm system.
5.8 Current Telehealth provisionSutton started a telehealth pilot project in August 2014 focussed on falls prevention and reducing hospital attendance resulting from fractured neck of femur. The results of this pilot will help to develop an evidence base for the benefits of telehealth which will inform future commissioning of telehealth services.
5.9 Provision of Daily Living AidsThe provision of daily living aids is met by the Integrated Community Equipment Service (ICES) delivered by Croydon Equipment Solutions. Daily living aids are available to residents to purchase themselves from the Aztec centre in Croydon and there is limited availability through pharmacies and local DIY stores.
5.10 The table below shows the provision of equipment and minor adaptations during 2013/14 by the ICES service.
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0 500 1000 1500 2000 2500
toileting
Minor Adaptation
Bathing
Bed Accessories
Cushion
Mattress
seating
walking equipment
small manualhandling
Bed
sling
domestic
special
sensory
hoist
Suctionmachine/neubulizer
or accessories
ramps and steps
large manualhandling
equipment issuedfor children
Sutton Equipment and Minor Adaptations 2013 - 2014
Number
6 Feedback from residents and practitioners6.1 Eldercare carry out an annual, random 5% sample, customer satisfaction
survey. Results for 2013 showed:
97.1% of respondents would recommend the service to others. 61.6% of respondents were ‘very satisfied’ with the speed that the
response centre answered their call. Another 32.7% were ‘satisfied’. 96.5% of respondents thought that the service represents value for
money
6.2 Anecdotal evidence suggests that telecare provides carers with peace of mind and helps make their caring role more manageable as this provides them with the reassurance that if something should happen when they are not around then the person they are caring for can call summon assistance.
6.3 Feedback from social workers has indicated that equipment such as ‘Just Checking’ is a valuable tool in understanding how telecare equipment can be
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used most effectively, particularly when assessing people with cognitive impairment where they may not recall their daily living habits accurately.
6.4 The START(reablement) service has identified that as Telecare is provided outside of the START service option and is not free for the first 6 weeks, the processing time for support planning and financial assessment can lead to delays in telecare being installed to support discharge from hospital.
7 How has assistive technology been used elsewhere7.1 The Government has supported several large scale initiatives to assess the
benefits of integrated care supported by Telecare and Telehealth in particular the Whole System Demonstrator (WSD).
7.2 Whole System Demonstrator (WSD)The Whole System Demonstrator (WSD) started in 2008 and set out to assess telehealth and telecare in three areas (Cornwall, Kent and Newham), it involved 6,191 patients in 238 GP practices.
7.3 Telehealth findings from the WSD trial were first released as headline findings by the Department of Health in December 2011. The findings reported the following reductions for people involved in the trial when compared with patients on usual care:
45% reduction in patient deaths 20% reduction in emergency hospital admissions 14% reduction in elective hospital admissions 15% reduction in A & E visits 14% reduction in hospital bed days 8% reduction in NHS costs
7.4 London Borough of Havering The London Borough of Havering have seen significant benefits over the past two years for adult social care clients with a combined package of telecare and homecare, compared to a similar group of clients receiving just a package of homecare. These benefits include a reduction in hospital admissions including a reduction in admissions due to falls, a reduction in admissions to residential/nursing care as well as users reporting an improvement in their quality of life.
7.5 In January 2013 a survey was conducted for recipients of assistive technology and their carers, 69 service users (35.57%) and 29 carers (36.25%) responded – the feedback was similar for users and carers.
Between 80% – 90% agreed that people generally ‘feel better’ with the assistive technology in place.
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Between 50% - 60% agreed that assistive technology prevents escalation to hospital or residential care.
7.8 Better Nights – An evaluation of Choice Support in SouthwarkAn initiative by service provider Choice Support to remove waking night staff from community-based supported living services for people with learning disabilities has saved a local authority £250,000. The report, Better Nights, by think-tank the Centre for Welfare Reform, found that replacing waking night staff with sleep-in staff and assistive technology in services to 26 people with learning disabilities resulted in better outcomes for people using the service.
7.9 Report authors Professor Roger Ellis OBE and Professor David Sines CBE, of the Social and Health Evaluation Unit of Bucks New University found:
• A £256,902 per annum saving for Southwark Council• 10 examples of qualitative improvements in peoples’ lives.
They added that risks were properly assessed and ameliorated using assistive technology, and that there was full stakeholder consultation in what was a well-managed project.
7.10 London Borough of CroydonOne of the reasons people with dementia are more frequently admitted to hospital is that they are often unable to communicate that they feel unwell which means that their condition is not identified until it reaches a more advanced stage. In order to prevent this London Borough of Croydon has used multi-user telehealth hubs in care home settings for people with dementia.
7.11 Early concerns that residents with dementia might resist having their vital signs taken have proven to be unfounded and the telehealth monitoring has become another opportunity for social interaction between staff and residents which is valued by both parties. Staff report that it has helped them to better understand the residents’ health needs and has empowered them to manage their care more proactively.
7.12 London Fire BrigadeIn his introduction to the Dementia Friendly Technology Charter, Ron Dobson, Commissioner, London Fire Brigade says:‘We all need to take fire safety seriously, but fire can pose a much greater risk for people living with dementia. This charter is a key document which aims to raise awareness of the importance of identifying and eliminating fire safety risks in the homes of people living with dementia. In particular, it points to
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technology enabled services such as monitored smoke detectors, as potentially life-saving solutions for people living with dementia’.
7.13 Torbay CouncilTorbay Council provide community alarms free for the first 3 months while someone is undergoing a period of assessment or rehabilitation to determine their long term care needs. After the 3 month period the client decides whether or not they want to continue with the service or to have the funded alarm removed. If they decide to continue the service with the existing provider they would not have to pay the normal installation fee.
7.14 High-Tec supported housing (Brandon Trust/Advance Housing/Gloucestershire County Council)The scheme accommodates 10 people aged from 18 to 45 with mild to moderate learning disabilities and physical disabilities. Each flat has its own assistive technology “hub” including a button which allows tenants to speak to guests and release the main front door from their flat. Tenants can also contact staff using an integrated or remote call button with a two-way speech channel from their flats or the communal areas of the complex. There is a key fob system which lets tenants who can’t manage a key open their own doors. Additional technology for people who are hard of hearing include a flashing doorbell a vibrating pillow alarm and a flashing alarm that are triggered by fire and smoke.
7.15 Support staff have their own centrally located technology “hub”, which receives information from sensors in the flats and informs staff, via a phone, that help is needed, The sensors pick up anything from a carbon monoxide leak to someone getting out of bed or having an epileptic seizure at night, depending on the occupant’s needs.
7.16 Assistive technology enables risk to be managed in a way that ensures people are safe without fostering over-dependent relationships with staff. Living with a greater degree of independence helps people to more readily acknowledge their own skills and competence and encourages their aspiration for greater independence.
7.17 Developments in technology mean that day to day devices are increasingly being use to meet support peoples, examples include:
Skype Apps that provide voice, sound and vibration feedback to maps to both
augment and replace visual feedback – this has proved useful for people with a vision impairment
The use of games consoles, such as Wii, in the rehabilitation for stroke survivors to enable them to undertake activities of daily living
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8 Issues8.1 Whilst there is evidence that assistive technology plays an important role in
increasing choice and control, enhancing and maintaining independence as well as reducing and delaying the need for statutory social care services and admissions to hospital, the take up of these technologies is low.
8.2 National research and feedback from practitioners indicates that following issues are barriers to increasing the use of assistive technology in Sutton:
Awareness People are not aware of the range of assistive technology that is available
and how it can be of help to bridge the gap between changing ability and the everyday activities that people want to do. This extends to front line staff in the voluntary sector and to a lesser extent health and social care staff
People do not see the relevance of assisted technology to their lives and cannot imagine themselves using it.
People do not know where to go to purchase assistive technology and support services
Confidence in products Mindset – fear of technology or fear that technology will replace physical
care People want to be able to ‘try before you buy’ and have money back
guarantees People considering purchasing products or services often like to know how
effective other people have found them. The ability to access customer reviews would be helpful to prospective consumers.
Compatibility Sheltered Housing schemes hard wired systems do not always enable the
addition of telecare sensors and therefore require dispersed alarm units to be installed
Evidence Base The evidence of the benefits of telehealth is mixed
9 Plans to address these issues
9.1 A draft action plan has been developed to address the issues identified, this is attached at Appendix 1.
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Draft Action Plan
Objective/Outcome How will we achieve this Measures &Targets
Timescale
1 Increase awareness of technology
Improve the information available on Council’s website explaining how technology can support people to remain living in their own home.
Include links to national websites that support people to understand what technology is available to meet their needs e.g. www.asksara.dlf.org.uk
Continue to deliver training to front line staff (Social Workers/Occupational Therapists) and staff in the voluntary sector about technology that is available and how it can meet identified needs
Use community festivals e.g. St Helier Festival to promote assistive technology
Presentations about the use and benefits of assistive technology at provider forums
The public are aware of the benefits and
availability of technology
Front line staff are aware of the benefits and
availability of technology
The public are aware of the benefits and
availability of technologyProviders are aware of the benefits and availability of
technology
October 2015
April 2015
Ongoing
September 2015
July 2015
2 People have confidence in equipment and can test the benefits before committing to buying
Work with providers to explore the option of ‘try before you buy’ for customers wanting assistive technology
Work with providers to explore the option of money back guarantees for equipment
People have the opportunity to try
equipmentJuly 2015
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Objective/Outcome How will we achieve this Measures &Targets
Timescale
3 Redesign Processes All support plans evidence that assistive technology has been considered to meet a person’s needs
Use ‘Just checking’ routinely to inform assessment, review and support planning for clients with dementia
Increased use of technology in assessment
and care planning
May 2015
4 Develop Market and improve compatibility
Engage with local retailers to encourage them to provide access to a broad range of assistive technology solutions
Work with Eldercare to investigate the possibility to extend the range of technology they provide within their shop
Commissioners work with housing providers to ensure that developments facilitate the use of assistive technology and consider compatibility issues
Assess the potential of using multi-user Telecare hubs in residential/nursing care settings to reduce hospital admissions
Introduce an online choose, book and buy option for assistive technology to include the functionality for customer reviews
The public have greater access to technology
locally
Increased potential for assistive technology to be
used
Increased use of technology to prevent hospital admissions
The public have easier access to technology
October 2015
Ongoing
November 2015
November 2015
December 2015
5 Increase evidence base for telehealth
Evaluate the Telecare/Telehealth pilot to test the effectiveness of technology in reducing fractured neck of femur in patients with a history of falls and any other benefits identified by the pilot.
Clinical staff have local evidence of the benefits of
technology
October 2015
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Appendix 2
PRODUCTS AND THEIR USES
DAILY LIVING AIDSThese devices provide prompts/reminders, or a physical barrier to reduce risks. Generally low cost, low tech, simple solutions to be considered as a first option, examples include:
Thermostat covers to prevent inappropriate adjustment of heating Lockable socket covers to prevent tampering of electrical items (especially turning
on or off) Magiplug flood prevention device that automatically allow water out when the level
exceeds a threshold Memo minders which allow a recorded message to be played when a person
approaches an area of potential risk (such as an exit door) Mem-X Vocal Reminder with a 12 month calendar that can store up to 90, 10
second messages MemRabel 11 Big Time & Day Display Clock with 10 daily alarms, real time clock
display, with the ability to store family videos, photo slide shows or text data Lockable isolation switches for gas appliances Low Blood Sugar Alarm Photo Dial Phones Pendant dialler telephones Water overflow alert Battery operated PIR Movement Activated Light
TELECAREIn its most simple form this is a wireless trigger connected to either a carer pager or a 24 hour monitoring centre. Additional electronic sensors can be added to manage specific risks in order to support vulnerable people to maximise their independence at home. Alerts can be customized to the particular person's risks and needs. When the alert is triggered, a message is sent to a carer or 24 hour monitoring centre who then provide an appropriate response. Examples of telecare include:
Monitored by 24 hour on site careA range of sensors connected to a carers pager for use when 24 hour on-site care is available from a parent, partner or carer.
Epileptic Seizure Monitors Advanced Seizure Detection Apnoea Monitor Enuresis Monitor Bed/Chair leaving alarms Pendant with alarm pager Floor pressure mat with pager alarm PIR Transmitter with pager alarm Sound activated transmitter Door contact transmitter Video/Audio Wireless Monitoring Camera System
Monitored by a 24 hour call monitoring centre
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In its most simple form this is a basic community alarm unit with a wireless trigger. Additional electronic sensors can be connected to the community alarm unit to help carers manage risk and help vulnerable people stay independent at home longer.
Alerts can be customized to the particular person's risks. When the alert is triggered, a message is sent to a carer or monitoring centre who can respond appropriately. In Sutton this service is supported by a team of local responders who can provide a personal response to alerts. Smoke detectors, gas detectors, carbon monoxide detectors, to manage environmental
risks Falls detectors, passive infra-red detectors, bed /chair sensors to detect movement and
falls Property exit sensors to detect if someone leaves the property
Location DevicesLocating devices use a transmitter installed in items such as a wristband, watch or mobile phone. A wristband or watch can be worn at all times and does not require the user to operate the device. A mobile phone, on the other hand, does require the user to remember to carry it and know how to use it. The best choice depends on the person.
A global positioning system, or GPS, uses radio signals transmitted from satellites to electronic receivers to identify the location of a person wearing a transmitter. Different devices use different methods of locating. Some may rely solely on the carer to receive a call or alert and start a search. Other devices may use a computer, telephone, mobile phone, call centre operator and/or direct contact with authorities. In addition, some systems send out an alert when a boundary is crossed (a predetermined, adjustable "geofence").
This type of system is exact to within a few metres. It is intended for outdoor use but may not be able to pinpoint the location if the satellite signal is affected e.g., under bridges, with electrical interference or in very dense bush. Typically it will not work in buildings, underground or underwater.
Some systems allow the carer to track the person using an Internet map, while others allow carers to define safe boundaries for the person. (A signal will be sent if the person goes outside of the set boundaries.)
On newer mobile phone models, the user can activate a locating system, usually by dialing 911. This system relies on the person to carry the phone and know how/when to use it.
Vega Watch Buddi MindMe St Bernard GPS Watch Tracker Mobile Phone Personal Tracker Vehicle Tracker (suitable for motability scooters or powered wheelchairs)
Just CheckingSmall wireless sensors in the main rooms of the home generate a chart of activity as the person goes about their daily life. Information is available to view via a secure web site, access can be provided for carers.
Used by social services for a few weeks as a tool in the assessment of people with cognitive impairment, this service can be purchased by self funders for longer term use.
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Telehealth
A service that ‘uses equipment to monitor people’s health in their own home by monitoring vital signs such as blood pressure, blood oxygen levels or weight’ (Department of Health 2009).
People use the equipment at home, to measure the vital signs that would normally be measured by a health care professional, helping to reduce frequent visits to the GP surgery. It is also anticipated that telehealth may reduce the number of unplanned hospital admissions by helping to identify changes in people’s health status before any problems become serious enough to warrant emergency intervention. The data is transmitted automatically via broadband or a dial-up telephone line to a monitoring centre or health care professionsal. Readings that indicate changes outside the normal parameters, which may indicate deterioration in health, are then flagged for action.
Telecoaching Tools designed to facilitate patient self-management and patient education. This type of service can help patients manage chronic conditions more effectively or help at-risk patients avoid developing more serious conditions. Examples include websites and mobile apps that provide diet tracking and improvement, coaching for smoking cessation, mental health management, stress management, and coaching for pre-diabetic patients. TeleCoaching services can be delivered via live connection to a carer (such as over the telephone) or via the web, instant messaging, e-mail, texting, or apps. Ideally, such tools are designed in a way that makes the coaching feel as interactive and personalised as possible.
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Appendix 3
Integrated Impact Assessment Assistive Technology Strategy 2014
Section 1: Aims and demographics
a. Is this a new policy or a review of an existing policy or service?
The Borough has had an Assistive Technology Strategy in place since 2006 to shape the management and development, primarily, of Telecare services within Sutton. Although the current strategy covers the period 2012-15, it focuses heavily on the need to procure an all-in-one, referral to response Telecare service. This work has now been completed and the new contract commenced on 18th November 2013.
The ground-work has been done in relation to Telecare and we have a provider with extensive experience of delivering all elements of the service, not tied to one equipment manufacturer. Now that they have a local base in Sutton they are also able to offer a broader range of equipment and services to self-funding clients. This means that there is a solid foundation in place for Telecare (and Telehealth) development in Sutton.
The provision of daily living aids is met by the Integrated Community Equipment Service (ICES) delivered by Croydon Equipment Solutions. Daily living aids are available to residents to purchase themselves from the Aztec centre in Croydon and there is limited availability through pharmacies and local DIY stores.
Sutton is starting a telehealth pilot project in August 2014 focussed on fall prevention and reducing hospital attendance resulting from fractured neck of femur. The results of this pilot will help to develop an evidence base for the benefits of telehealth which will inform future commissioning of telehealth
Commissioners are working with extra care housing providers to maximise the potential for, and facilitate the use of technology in new and existing developments.
We now need to consolidate and build on the work that has already been done. Updating the Assistive Technology Strategy will allow us to widen its scope to include daily living aids, Telecare, Telehealth and telecoaching as well as the services that support this technology, and ensure that these can be accessed by the whole population of Sutton when required by:-
1. Increasing product knowledge, highlighting the benefits & availability of solutions, including utilising web sites such as ‘Ask Sara’ (www.asksara.dlf.org.uk) to identify the most appropriate solution for the person/situation.
2. Embedding signposting to/promoting the use of, a wide range of technology into all information/advice/assessment/ support services
3. Identifying opportunities for introducing or increasing the use of technology
4. Taking advantage of innovation and product development as it comes to market
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5. Driving forward service developments and protocols which support the greater use of technology
b. What are the aims and purpose of this proposal?
At a time of significant pressures on budgets and services, Technology has the potential to improve the lives of some of the most vulnerable people in our society in a cost effective way. It can give people greater control to manage and maintain their health and place them at the centre of their own care and support, and in doing so, provide them with a better service and better quality of life.
Technology, used appropriately, can reduce the burden placed on carers, assist in the management of long term conditions, reduce hospital admissions and reduce or delay the need for residential/nursing care.
The action plan which accompanies the Assistive Technology Strategy should lead to the following benefits:
Product information is widely available to support self help and self management for all residents, including health clients, clients with direct payments and self funders
A wider understanding of how technology can facilitate greater control for people to manage and maintain their health and place them at the centre of their own care and support.
Greater awareness of where to go to purchase assistive technology Increased confidence in the products generated through case studies and
customer reviews of products Identification of opportunities to ensure the provision of assistive technology is a
preventative mechanism for intervening before issues become a crisis. Identify how technology can deliver against medium term cost savings. Recommendations for improvements to pathways for residents/carers to
facilitate ease of access to appropriate information, advice and support when they need it.
Improvements to the customer experience for residents accessing assistive technology in the Borough.
Inform future commissioning intentions for assistive technology that focus on providing a coherent and joined up approach and deliver better outcomes for residents, including developing the market to support self funders.
c. Which of the geographic areas does this proposal affect? (insert any specific wards or state all borough)
All Borough
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Section 2: Equality and diversity
a. Which stakeholder group or groups does this proposal affect? (e.g. Staff at LBS, residents, third and voluntary sector)
Residents, their carers’, LBS staff as well as the third and voluntary sector.
b. Whose needs is the proposal designed to meet? (e.g. include any specific impact on protected group members e.g. older people, disabled people, BME),
Older and disabled people and their carers, Children (aged 0-19) with a disability and their carers. These will include people from all other protected groups.
c. What evidence has been collected to inform this proposal?
There were 191,123 people living in Sutton at the time of the 2011 census and this is projected to rise to around 222,000 by 20212. The population is predicted to increase, not only in size through increasing birth rates and migration, but the population is also increasing in age.
The figures below show the expected percentage increase in population between 2011 and 2021 by age.
Age Expected % Increase in Population
65+ 18.7%
75+ 17.1%
85+ 2.3%
Carers In 2011 over 18,000 people in Sutton (9.6%) reported providing some level of unpaid care to family or friends.
Children (aged 0-19) with a Disability887 children were registered with Sutton’s Children’s Disability Database in July 2012; including learning disabilities, physical disabilities and communication difficulties.
People with Learning Disabilities Sutton’s profile of people with learning disabilities is unique compared to other parts of England, with older populations of people with learning disabilities than previously expected and this trend is projected to continue.
People with Dementia Currently there are estimated to be 2,000 residents in Sutton living with dementia, with only 700 of these having a dementia diagnosis. Of these at least 150 with a primary
2 2011 Census
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need to dementia are currently supported by social services. The number of people living with dementia is expected to increase by 18% to 2,360 by 2021.
It is estimated that 63.5% of people with dementia live in the community, of whom two thirds are supported by carers and one third live alone. Approximately 36.5% live in care homes. The majority of residents in care homes for older people have a form of dementia.
People with Long Term Conditions The number of people aged over 65 years with a limiting long term illness is projected to rise from 11,570 in 2010 to 17,670 by 2030.
One of the key consequences of people living longer lives is that they are more likely to develop long term conditions particularly if they have less healthy lifestyles and/or are disadvantaged. These long term conditions are likely to become increasingly complex over time requiring additional support either in peoples own homes or in residential or nursing accommodation if preventative services (primary and secondary) are not in place early to avoid this. Commissioners for health and social care need to work in partnership to ensure prevention and early intervention services are in place and accessible for all to reduce the risk of future complex needs3.
People at Risk of a FallThe consequences of falling can be minor, but with increased frailty and osteoporosis the consequences can be significant, resulting in a fractured neck of femur.
The rate of Hip fractures in people aged 65 and over is 486 per 100,000 in Sutton. For over 80 year olds the rate is much higher (1,516 per 100,000).
d. What equality-related information, for example through consultation with stakeholders, has been gathered on this proposal? (indicate the type of information gathered and ensure you address ethnicity, disability, gender, age, religion and sexual orientation. You can also include people with caring responsibilities. Attach a summary or refer to where the evidence is held.)
A series of research activities were undertaken in the first stage of a national three year project known as COMODAL – consumer models for Assisted Living. COMODAL is led by Coventry University in partnership with Age UK and Grandparents plus, as part of the Assisted Living Innovation Platform and funded by the Technology Strategy Board.
The research suggests three distinct segments within the consumer market:(i) Prospective consumers – people who have yet to buy or use assisted living
technologies(ii) Consumers – people who already buy assisted living technologies either for
themselves or someone else(iii) Non purchasing users – people who use assisted living technologies that they
did not purchase themselves
The aim of the initial stage of the project was to develop a deep understanding of the needs of younger older people (age 50 – 70) as both users and purchasers of assisted
3 JSNA 2011/12
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living technologies (ALT) and to investigate the barriers and enablers to ALT adoption for this group. 500 street interviews were undertaken in five representative locations across the UK, including Scotland and Wales. Consumers were asked to rank the importance and influence of the barriers and enablers to purchase and use of ALT products and services and were also asked about some of the wider factors that affect decision making about what product to buy and the purchase process.
The top three barriers that were ranked as having the strongest influence for the50-70 age group were: cost; knowing how to choose what to buy; and a lack of awareness that a product that might help exists. The top three enablers were: belief that a product would really make a difference; a feeling that costs are affordable and worth it; and a belief that the product would make life safer at home.
Differences were also found between different social economic groups (SEG)4 in theirapproach to the purchase of assisted living products. AB consumers are much more likely to listen to healthcare professionals for advice than any other SEG. Shopping via the internet was more important for consumers in AB and CI groups than for C2 and DE consumers.
However, friends and family are more important influences on the purchase decision than the internet for C2 and DE consumers. These trends are important for market segmentation and provide useful insights for industry in terms of how they promote their products.
Consultation with users, carers and the voluntary sector will take place in order to finalise the draft action plan.e. In what ways might the proposal impact positively or negatively on some
groups of people? (Please ensure you address ethnicity, disability, gender, age, religion and sexual orientation. You can also include people with caring responsibilities.) Technology is already being used successfully to support people with learning
disabilities to live in the community. Technology (Just Checking) is being used as part of Social Work assessment
to give a voice to people with dementia. Technology, used appropriately can delay or avoid a move to residential care
for people with dementia. Technology can support carers. Technology can provide increased confidence for older people with a history of
falls, encouraging them to mobilise in the knowledge that they can summon assistance if necessary.
If used inappropriately, technology can inhibit independence. Services and promotional information are operated in English and this will impact negatively on non-English speakers. Inadequate knowledge of the service may mean people with hearing or visual impairment may not receive information about the service or feel that it is not suitable for them.
4 The socio-economic groups (SEG) used in this survey were based upon the definitions published by the Market Research Society, Occupation Groupings: A Job Dictionary, 6th ed, 2006, with those in group A being defined as professional people, very senior managers in business or commerce or top-level civil servants and group E defined as those entirely dependent on the state long-term, through sickness, unemployment, old age or other reasons, unemployed, casual workers and those without a regular income.
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f. What will be done to promote equality of opportunity as part of this proposal?
By providing information in widely accessed media to reach people who are isolated and do not access mainstream servicesBy developing the potential of the provider market to reach a broad range of peopleWorking with the voluntary sector to raise awareness of technology, its benefits and how it can be accessed
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Section 3: Health and well being
a. In what way could this proposal positively or negatively impact on the physical and/or mental wellbeing of residents? If there is a negative impact what action will be taken to mitigate this? What evidence has been or will be collected?
Knowing that assistance can be summoned in the event of an emergency can provide reassurance and peace of mind for users and carers.
If used inappropriately, technology can inhibit independence. This will be mitigated through product awareness, ongoing training and access to information and advice.
b. In what way could this proposal have a positive or negative impact on an individual’s opportunity to improve their own health and wellbeing? If there is a negative impact what action will be taken to mitigate this? What evidence has or will be collected?
Assistive Technology can have a positive impact because it provides greater control to manage and maintain their health and place them at the centre of their own care and support and, in doing so, provide them with a better quality of life.
c. In what way could this proposal positively or negatively impact disproportionally on the health and wellbeing of one or more different communities? (e.g. improve the lives and health of a vulnerable group such as people with learning disabilities). If there is a negative impact what action will be taken to mitigate this?
Sutton is starting a telehealth pilot project in August 2014 focussed on fall prevention and reducing hospital attendance resulting from fractured neck of femur. The results of this pilot will help to develop an evidence base for the benefits of telehealth which will inform future commissioning of telehealth
Section 4: Local Economy
Is this section relevant to your proposal? No
Section 5: Sustainability
Is this section relevant to your proposal? Yes
a. Is this proposal sustainable medium or long term for improving services in Sutton?
The appropriate use of technology is both sustainable and cost effective.
b. Is this proposal a cost – effective use of resources?
Yes
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c. If applicable; does this proposal have any impact on the environment and One Planet Living Principles in Sutton? (e.g. does it impact upon reducing waste, encourage the use of carbon neutral modes of transport conserve the environment or encourage the efficient use of water? Please see guidance for further details if this is relevant to your policy or review).
Section 6: Actions and Publications
a. Please rate the overall impact identified through this assessment with the level of action that needs to be taken (delete as appropriate):
No major change required
b. What actions are going to be taken as a result of this IIA to address negative impacts or previously met unidentified needs?
The vision of the Assistive Technology Strategy is to significantly increase awareness and broaden the use of technology so that people maintain their independence for as long as possible thereby reducing and/or delaying the need for statutory services. The action plan which accompanies the strategy sets out actions to deliver this vision.
c. What data monitoring or evaluation activity has been put into place to monitor the impact of this proposal?
As at March 2014 293 people were receiving telecare as part of a social services package of care.
Service NumberBasic community alarm service + keyholders 91Basic community alarm service + Mobile Response 91Community Alarm + Telecare sensors + keyholders 36Community Alarm + Telecare sensors + Mobile Response 75Total 293
In addition to the 293 Social Service clients a further 915 residents purchase telecare service themselves from different providers that provide telecare in Sutton.
Total Number of Clients
Number of Clients with Mobile Response
Sutton Social Services clients 293 166Eldercare private clients in Sutton 565 89Age UK Aid Call private clients in Sutton 261 -Merton Mascot private clients in Sutton 51 24Mole Valley Telecare Services 38 -Total 1208 279
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The table below shows the provision of equipment and minor adaptations during 2013/14 by the ICES service
toile
ting
Minor A
dapta
tion
Bathing
Bed Accesso
ries
Cushion
Mat
tress
seat
ing
walking e
quipment
small
man
ual han
dling
Bedsli
ng
domestic
specia
l
senso
ryhoist
Sucti
on mac
hine/neubuliz
er
or acc
essorie
s
ramps a
nd steps
large
man
ual han
dling
child
ren
0
500
1000
1500
2000
2500
Sutton Equipment and MinorAdaptations 2013 - 2014
Sutton Equipment and Minor Adaptations 2013 - 2014
d. Sign- off ( Your completed IIA must be signed off by a Head of Service)
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