The mainstreaming of telehealthcare services will release substantial resources– how do you make it happen?

1. © 2008 Tunstall Group Ltd Confidential
The mainstreaming of telehealthcare services will
release substantial resources
– how do you make it happen?
Doing More With Less !!

2. 2© 2008 Tunstall Group Ltd
Presentation Team
• Kevin Alderson
– Public Sector Policy Director
• Andrew Bailey
– Account Director - Wales and the West Country

3. 3© 2008 Tunstall Group Ltd
Areas to Cover
• Taking stock
– the Welsh Telecare programme has delivered a good
infrastructure, it now needs building upon
• Facing challenges
– finances will be tight for the foreseeable future whilst demand for
services continues to grow through demographic trends
• Maximising opportunities
– this existing infrastructure can deliver big savings for
redeployment if it is fully utilised
• Key Objectives:-
– Highlight the opportunity, through case studies
– Illustrate the route to mainstream services, based on best practice
in Wales and elsewhere
– Discuss how to make this happen across Wales

4. 4© 2008 Tunstall Group Ltd
Telehealthcare

5. 5© 2008 Tunstall Group Ltd
Flexible telehealthcare solutions
Monitoring Centre can support:
Administration duties,
Emergency response coordination
Lifestyle monitoring
Quantify results,
Coordinate installation and removal,
Equipment inventory
Valuable communication hub for the
whole service
Monitoring Centre
Telecare units and
Sensors in clients’
homes
Response in the
Community
Based in client homes
Extra care housing
Residential housing
Nursing homes etc.
Free phone
telephone
number

6. 6© 2008 Tunstall Group Ltd
Flexible telehealthcare solutions
Monitoring Centre can support:
Administration duties,
Non clinical triage
Quantify results,
Coordinate installation and removal,
Infection control
Equipment inventory
Valuable communication hub for the
whole service
Clinicians perform daily triage of
patient caseload
Monitoring Centre
Telehealth monitors
in patients’ homes
Clinicians,
Community and
Trust based
Based in patient homes
Extra care housing
Residential housing
Nursing homes etc.
Free phone
telephone
number

7. 7© 2008 Tunstall Group Ltd
How does Telehealthcare work?
Telehealthcare delivery model
Managed Response
Social Care, Housing,
Community Nursing,
Friends, Family,
Therapy, Meals,
Voluntary Services…
Emergency
Response
Response Centre
Alerts and
Reassurance
Social care health care housing education

8. 8© 2008 Tunstall Group Ltd
NURSINGSECURITY
MEDICALPERSONAL
SOCIAL
ENVIRON-
MENTAL
SAFETY
fire,
floods,
high temps,
low temps,
air quality,
noise,
hygiene
wandering,
falls, CO gas,
scalds,
unburnt CH4,
tampering,
cooker/µwave
misuse
incontinence,
pressure areas,
chronic disease symptoms,
medication compliance
Intruders,
bogus callers
door status
use of bed,
little movement,
bath monitor,
lack of contact,
poor nutrition
cardiac
arrhythmia,
asthma attack,
hypoglycemia
epileptic
seizure,
blocked
catheter,
apnoea
Continuum of Telehealthcare Services

9. © 2008 Tunstall Group Ltd Confidential
Evidence of the positive impacts
Citizens & Patients
Carers
Finances

10. © 2008 Tunstall Group Ltd Confidential
What has been happening in Scotland?
“JIT” (Joint Improvement Team)
– Telecare Development Programme

11. 11© 2008 Tunstall Group Ltd
Quality of life of users of telecare services
Telecare’s impact on specific aspects likely to affect users’ quality of life?:
• Over half (55.2%) of the respondents felt that their health had not changed,
whilst slightly more than half of the other respondents (comprising 27.1% of
the total) thought that their health had improved;
• Almost all (93.3%) respondents felt safer;
• Over two-thirds (69.7%) felt more independent;
• Very few (3.5%) felt lonelier;
• Four-fifths (82.3%) either “disagreed” or “strongly disagreed” that they felt
more anxious and stressed;
• Most (87.2%) thought that their families now worried less about them;
• About two-fifths (40.8%) felt that their equipment had not affected the amount
of help they needed from their family, whilst about one-third (32.8%) felt that
they needed less help.
York Health Economics Consortium at York University/Scottish Government Final Evaluation Report, Jan 09
http://www.jitscotland.org.uk/action-areas/telecare-in-scotland/telecare-publications/

12. 12© 2008 Tunstall Group Ltd
Reduced pressure on informal carers
• Three-quarters (74.3%) of the respondents felt that telecare equipment has reduced
the pressures on them by reducing their stress levels
• Fewer than one-in-twenty (4.3%) felt that their stress levels had increased;
• Carers generally felt that the equipment gave them peace of mind as they worried
less (e.g. about falls);
• They felt that people with learning disabilities could enjoy greater independence and
that the equipment could enable people with dementia to remain living in the
community for longer;
• Even if stress levels had fallen, several respondents highlighted that caring can still
be very demanding and stressful (especially if the client will not use their equipment);
• However, many carers were very positive about the telecare service and also very
grateful for it.
York Health Economics Consortium at York University/Scottish Government Final Evaluation Report, Jan 09
http://www.jitscotland.org.uk/action-areas/telecare-in-scotland/telecare-publications/

13. 13© 2008 Tunstall Group Ltd
Telecare in Scotland – prevention and efficiency!!
Outcome Minimum
target for
2007-2010
Actual achieved
Apr 07-Sep 07
Actual savings achieved
Apr 07-Mar 08
Est monetary saving
Hospital bed days saved by facilitating
speedier hospital discharge
46,500 1,800 5,668 days
517 discharges
£1.7m 15.5%
Reduced unplanned hospital admissions -
bed days saved
Info not avail Info not avail 13,870 days
1220 admis
£3.34m 30%
Care home bed days saved by delaying
people to enter care homes
225,000 6,900 61,993 days
518 admis
£3.42m 30.7%
Nights of sleepover care saved 46,000 1,250 Info not avail £0.55m 5%
Home check visits saved 905,000 107,000 Info not avail £1.79m 6.1%
Locally identified savings eg reduced waking
nights
Info not avail Info not avail £0.30m 2.7%
No. of TDP funded telecare users 13,505 6,005 7,902
Estimated verifiable savings as a result of
Scotland Telecare Dev Prog
£43m £2.9m £11.15m
York Health Economics Consortium at York University/Scottish Government Final Evaluation Report, Jan 09
http://www.jitscotland.org.uk/action-areas/telecare-in-scotland/telecare-publications/

14. © 2008 Tunstall Group Ltd Confidential
Key English Telecare Case Studies
North Yorkshire

15. 15© 2008 Tunstall Group Ltd
North Yorkshire Cost Benefit Analysis
Average 38% saving in care packages
• The last 138 people assessed for telecare during the period of Sept 2008 were
analysed. Some people were new to ACS and some were pre-existing with traditional
support
• 7 cases were disregarded as outliers as it was felt they skewed the data too
favourably thus final total is 131 people analysed
• Traditional packages were either the support that had previously been received (if
pre-existing case) or for support to new people was based on care manager’s
professional assessment of need if Telecare had not been available.
Service type
Count of
users
Annualised
cost £
Traditional
Ave cost £
annualised
cost £
Telecare
enhanced
package
Ave cost £ Variance £
% reduction
in traditional
package £
Ave
efficiency
£
Residential care 60 784775.16 13079.59 417511.19 6958.52 355053.06 45% 5917.55
Community
Support 71 480024.46 6760.91 356336.33 5018.82 123688.13 26% 1742.09
All packages 131 1264799.6 9654.96 773847.52 5907.23 478741.19 38% 3654.51
Traditional package Actual package of care used including Telecare

16. 16© 2008 Tunstall Group Ltd
Evaluation Outcomes
“Traditional” v “Telecare enhanced”
• 46% of the traditional packages would have been residential, EMI or nursing
and 54% at home
• Those who would have had more than 10 hours home care saw a reduction
in the number of hours needed
• The trend for those who would have received 7 hours or less was a
reduction in the number of hours with some people needing no further
support
• Analysis indicated a net average annual efficiency per person £3,654
countywide
• 38% reduction in care package costs.
• Average of the sample (131) and grossing up for all those clients utilising
Telecare for over a year (330) gives net figure £1,108,609.

17. 17© 2008 Tunstall Group Ltd
Scrutiny Committee gives Telecare
mainstreaming the green light – 2007
In 2006/7 Care and Independence Overview and Scrutiny Committee
examined the Implementation of Telecare in North Yorkshire. The report of
the Chair of the Assistive Technology and Telecare Working Group 01/02/07
concluded that:-
• When Telecare has been implemented by authorities in a “big way” the
evidence is the results can be quite startling, notably in terms of
releasing hard pressed resources.
• Telecare must not seen as an alternative to human contact, nor is it seen as
an opportunity to police people. It is about supporting and managing risk,
not about controlling behaviour.
• Members concluded, to gain the greatest efficiencies with resources that
preventative use prior to the service user becoming critical will derive the
maximum gains for organisations, users and carers.

18. 18© 2008 Tunstall Group Ltd
Satisfaction survey
• A Directorate survey carried out in Spring 2008 which had 96 respondents indicated
the following outcomes.
• 86% - Telecare has helped me to carry on living at home
• 90% - Telecare equipment has given me more confidence/peace of mind
• 95% - Telecare equipment has helped me to feel safer
• 92% - Rated Telecare excellent or very good overall
• 86% - Rated the assessment excellent or very good
• 92% - Were happy with the installation
• Of the respondents, 80% lived alone and 45% were owner occupiers.

19. © 2008 Tunstall Group Ltd Confidential
Key English Telecare Case Studies
Stockton

20. 20© 2008 Tunstall Group Ltd
Evidence ensures mainstreaming of service
BACKGROUND
• number of over 65s will increase by 46% by 2021
• 20% of the population report having a limiting long term condition
OUTCOMES
• A draft evaluation was taken to the Adult Care Partnership Board which showed
that overall savings were estimated to be £600,000 pa gross and £220,954
pa net
• The 13 month pilot directly supported the mainstreaming of telecare services in
Stockton
• £400k funding over 2 years secured, £300k from PCT (local delivery plan
arrangement) and 100k social services (adult social care fund)
• 270 people using telecare (defined as 2 or more pieces of equipment). In
addition there are 4500 community alarm service users

21. 21© 2008 Tunstall Group Ltd
Reduction of care home/domiciliary care hours
Each telecare client receives a six week joint review and at the time of this
report (May 2008), 90 reviews had been completed with social work
professionals stating that:
• 42 Telecare installations will delay care/residential care admission and
eventually lead to a reduction in care home admissions. (47%)
• 26 Telecare installations have resulted in stopping a care home admission.
(29%)
• 11 Telecare installations have resulted in no economic benefits. (12%)
• 7 Telecare installations have resulted in reduced domiciliary care hours.
(8%)
• 4 Telecare installations have resulted in stopping nursing care home
admissions. (4%)

22. 22© 2008 Tunstall Group Ltd
Hospital A&E attendance avoided/bed days saved
The key statistics when looking at this is the sensors detecting incidents early and
making the service aware that there may be a problem.
• This is highlighted by the main key incidents of sensor activity.
– 64 Clients found on the floor.
– 31 “Client Walking” activations where clients were found and returned safely to their
property.
– Of these 95 incidents only 7 of the “clients on the floor” category led to
ambulances called and attending the hospitals accident and emergency services.
• With Telecare staff attending the remaining call outs within an average of 14 ½ minutes
from the time the incident has occurred it could be assumed due to the nature of the
incidents the service has saved the local PCT:
– 88 Ambulance call outs, in the region of £13,904 at an average £158 per call out.
£158 is average cost of an ambulance call out.
– £6,424 saving in A&E admission based on £73 per call average standard cost of
A&E admission. (PCT average Standard A&E admission)
– £66,528 in bed days saved if each case had resulted in a 2 day hospital stay.
Based on £378 per day hospital bed. (PCT average cost per day of hospital bed
2008).

23. © 2008 Tunstall Group Ltd Confidential
Key English Telehealth Case Studies

24. 24© 2008 Tunstall Group Ltd
NHS Blackpool and Vitaline
• Delivering telehealth for over 3 years
• COPD, HF, Diabetes, Partnership with Community Matrons
• The PCT and Social services wrote up their findings and they have
had a:
• 75% reduction in hospital admissions,
• 48% reduction in home visits by community matrons,
• 85% reduction in GP contacts.
• Mainstream progression and expansion

25. 25© 2008 Tunstall Group Ltd
NHS Blackpool and Vitaline – 12 month study

26. 26© 2008 Tunstall Group Ltd
NHS Blackpool and Vitaline – 12 month study
• 100% Equipment is easy
to use
• 80% Since having telehealth
I understand my condition better
• 80% I have less anxiety
• 70% managing my condition
at home through telehealth
has enhanced my quality of life

27. 27© 2008 Tunstall Group Ltd
Orchard Medical Centre – PbC project
• Primary care (GP Practice) based (Orchard Medical Centre)
• Led by GP’s, operationally run by district nursing and practice staff -Heart failure
focussed - Started March 07
• PbC service change business case (Key outcomes and benefits trialled trialled)
• Quality of life for patients improved
• Increased knowledge and understanding of health promotion issues relating to
heart failure, both by nursing staff and patients to troubleshoot problems and
make small changes that will impact on long term health.
• Reduction in hospital admissions leading to a reduction in bed days demanded.
• Reduction in hospital acquired infections and their complications by this frail and
vulnerable group
• Improved safety during complex medication alteration
• Increased skills in the community and practice team
• Increased skill mix in the combined team, with a further opportunity to work
seamlessly in the primary care team
• Pilot successful - now expanded and embedded into standard care within the
practice

28. 28© 2008 Tunstall Group Ltd
Impact on Doctors Time
Doctor Use
0
1
2
3
4
5
6
M
arch
A
pril
M
ay
June
July
A
ug
S
ept
O
ct
N
ov
D
ec
Jan-08
Month
contactsperuser
Doctor Tel Calls
Doctor visits
Doctor in surgery
total doctor demand

29. 29© 2008 Tunstall Group Ltd
“I’d be lost
without telehealth”
• Margaret has severe heart failure
and would often forget to take
medication leading to regular visits
to A&E
• She has not used out of hours
health services at all in the last
year
• Telehealth gave Margaret
increased reassurance leading to
improved medication compliance
and less visits to the hospital
Case study – OMC

30. 30© 2008 Tunstall Group Ltd
Example large scale telehealth services
Whole System Demonstrator
• Tunstall is involved in all three WSD sites - Kent, Newham, Cornwall –
covering 6,000 people
• Cornwall: Major milestone achieved Aug 09 –
over 2000 people taking part:
– 1,100 telehealth patients
– 1,100 telecare clients
– Currently 1,100 in the control trial group
Successes
• Now mainstream funded for 1,100 patients year on year (Expanding
into Stroke, Hypertension and UTI)
• Effective internal service set up and project management
• Dedicated administration and technical team
• High awareness level and full clinical engagement
– GP, Community Matrons, Medical physics, clinical team,
and installation/de-installation team
• Formal evaluation is currently underway with research institutes.

31. 31© 2008 Tunstall Group Ltd
Example large scale telehealth services
NHS North Yorkshire & York:
• Mainstream funded – 2000 units (COPD, CHF, Diabetes, Stroke)
• ROI based on reducing acute sector demand and improving operational efficiencies
in primary care
• Full service & care pathway redesign – embedding “care at home” services into
standard service provision.
• GP, Case management and specialist clinical team critical to success - clinical
champions in all key areas (geographical and specialist)
• Full supporting service provision provided by Tunstall
– Service desk (referral, commissioning, assessment and contact)
– Single access sign on
– Clinical consultancy
– Project management
– Outcomes evaluation

32. 32© 2008 Tunstall Group Ltd
Large scale Telehealth deployment &
service redesign delivers a net ROI of 1.9
• Indicative PCT of population 800,000
• Total net savings of £9.1 million over 3 years
• Annual net savings £5.1 million year 4 onwards
• Net return on investment first three years 1.9
• 2,000 patients (Heart Failure, COPD, Diabetes)
– Telehealth technology supply: equipment packages, triage software, communication
fees, warranty/maintenance, consumables
– Managed services: installations/de-installations, service desk, training
– Care at Home Service redesign, LTC care pathway redesign and project support

33. © 2008 Tunstall Group Ltd Confidential
Overview of integrated telehealthcare
service
ICP
Integrated Care Platform

34. 34© 2008 Tunstall Group Ltd
ICP
Integrated Care Platform
Identify
Patients &
condition
Service
Management
Self Care &
Monitoring
Data Capture
& Processing
Clinical
Decision
Support Coaching &
Education
patient

35. 35© 2008 Tunstall Group Ltd
Managed Services that support care
delivery transformation
Identify
Patients &
condition
Service
Management
Self Care &
Monitoring
Data Capture
& Processing
Clinical
Decision
Support
patient
Coaching &
Education
Transforming Care
Delivery
Service and
Pathway re-design

36. 36© 2008 Tunstall Group Ltd
36
ICP: Provide the building blocks….
Identify
Patient
& Needs
Service
ManagementSelf Care &
Monitoring
Data
Capture
& Validation
Clinical
Decision
Support
Coaching &
Education
Telecoaching
Health information
Patient Portal
Video Conference
patient
Health Surveys
Secure
Communications
N3 HostingTechnical Triage
Clinical Triage
Risk
stratification
Healthcare
portal
Patient Referral
Service Desk

37. 37© 2008 Tunstall Group Ltd
Tunstall Service Desk
Platform
Tunstall
telehealth
platform
2 way flow of patient details
Patients/Carers
Service
support staff
Online Referral Form
Referring clinicians
Multiple referral sources
Communication coordination
Trust staff
Other H&SC
platforms
System Integration
SLA Reports
Tunstall
telecare
platform
Integrated telehealthcare delivery…
…joining up health & social care
N3environment
Locally hosted

38. 38© 2008 Tunstall Group Ltd
How does Telehealthcare work?
Telehealthcare delivery model
Managed Response
Social Care, Housing,
Community Nursing,
Friends, Family,
Therapy, Meals,
Voluntary Services…
Emergency
Response
Response Centre
Alerts and
Reassurance
Social care health care housing education

39. © 2008 Tunstall Group Ltd Confidential
What are the barriers to making this
happen?
How do we make “mainstream” happen?
Discussion session

40. © 2008 Tunstall Group Ltd Confidential
Thank you for listening
kevin.alderson@tunstall.co.uk
07740 578000