Telecare Services Association Conference Wed 18 Nov 2009

November 16-18, 2009

Hilton London Metropole, W2 1JU

The cost of providing you with these reports has been supported by the conference organisers and
Home Telehealth Limited (UK)

home telehealth limited

Quick links to workshop reports, below:
Developing a telehealth service
Tellycare – delivering telecare and telehealth via TV
Protocols – from vision to reality
Safe at Home: Mental Health Intermediate care
Telecare assessment

Wednesday 18 November

Today’s contrast: Motivation and Motivational

This morning’s programme was relatively lightweight, much to the relief of a number of attendees, I suspect. First there was a chance to catch another workshop, then some last-minute calls to exhibition stands, followed by the mystery ‘motivational speaker’.

Although the attendee numbers were down on the previous days, there was no discernible lack of motivation amongst the people thronging the workshops and the exhibition. The ‘motivational speaker’ turned out to be Sir Ranulph Fiennes who talked about the nature of personal motivation with many humourous examples from his personal life and then went on to give some insight into what went into a couple of his amazing expeditions. He charmed everyone by downplaying the awfulness of the situations he found himself in and by letting his photos hint at that aspect. [Notes to self: a) Never volunteer for an expedition anywhere cold – more agony than ecstasy! b) Donate to his charity efforts when the opportunities arise.]

And the winners are…

tynetec winners

Alyson Bell, TSA Director, averts her eyes as she pulls out the name of Tynetec’s 30th birthday draw winners, who are:

1. Lynda East (Enhanceable) Wii Fit
2. Loraine Simpson (New Progress HA) IPOD Nano
3. Helen Gillivan (London Borough of Bromley) Champagne
4. Charlotte Walton (Cheshire West & Chester Council) Red Wine
5. Allyson McLeod-Hardy (Your Homes Newcastle) White Wine
6. Lesley Thomas (Salford City Council) Chocolates

Workshop reports


Tuesday afternoon. Reporter: PAUL MITCHELL, Independent Consultant

This mega-workshop built on the plenary session presentation earlier in the day from Dr Janice E Knoefel on Managing Chronic Medical Conditions by Telehealth amongst New Mexico veterans.

Professor Russell Jones of Brunel University chaired the workshop with considerable panache and vigour, but the star of the show was supposed to be the technology.

First up, Professor James Barlow of Imperial College, dealt with emerging evidence from pilots and research into the efficacy of telehealth, or what he termed ‘Remote Care’ in patients’ own homes. He lamented the huge volume of pilots worldwide (over 9,000) but the lack of mainstreaming of remote care. He acknowledged some small pockets of excellence, but observed that they tended not to spread into general practice. He diagnosed some barriers to progression into mainstream healthcare, which included:

  • A lack of integration between partners
  • The absence of obvious business cases for investment
  • Evaluations which were not sufficiently robust
  • PCTs which have switched resources away from special programmes to fund deficits elsewhere
  • Support for individual applications of telehealth but a lack of systemic adoption

He finished with a plea to change the system now to mainstream remote care.

Next up was Angela Single of Choose Independence consultancy, speaking about the nurse-led programme of health monitoring in South East Essex using community matrons in the absence of GPs’ willingness to get involved. In effect, the nurses decided to go it alone. They have so far achieved 80 cases of patient monitoring at home within four months of initial programme deployment. This involved developing robust systems and procedures for rapid procurement and deployment of telehealth equipment with full nurse support. Using a call centre setting to monitor health lifesigns data has forced the development of systems in ways for which they had not been designed. Most importantly, the programme has challenged traditional practices such as routine visiting and monitoring of patients. Patients are prioritised for attention, not necessarily involving physical visits, on the basis of triage. The procedures remain flexible to adapt to changing circumstances, such as accommodating delays by some patients in administering their medicine and measuring their personal health data in cold weather.

This was followed by Pam Bradbury and Dr Nicholas Robinson of NHS Direct. Their theme was telecoaching in Birmingham East and North PCT area by Pfizer Health Solutions, the PCT, and NHS Direct. Each partner has a well defined role to perform in this model of community-based health care, which has been integrated with the PCT’s model of delivery to patients with long term conditions. It includes a telephone-based care management process, with phone consultations that can last up to half an hour. There is a field team of 38 whole time equivalents composed of a mix of health coaches and nurses, supporting 4,800 patients.

The levels of discovery from this telehealth approach are said to be considerable. Results include a 48% reduction in hospital admissions and 53% fewer visits to A&E in this patient group.

Dr Mike Short, vice president of R&D at Telefonica Europe focused his presentation on challenging the trend of proliferating data hubs in the home. These could soon include dedicated hubs for telehealth, games consoles (e.g. Wii), broadband wi-fi, and smart utilities meters. He sketched a connected world in which, by 2013, there may be more mobile phones in the world than people; who have readily taken up new information and communications media such as Google, Facebook, and Twitter. He also reported a prediction that e-Health spend in Europe will double to 50 billion euros by 2010. Against this backdrop of exponential growth of information hubs in the home, he dangled the unspoken question of why we needed to introduce new dedicated health systems into the home when we already have all this other technology at our disposal which can be adapted for that purpose?

The final presentation was from Dr Justin M Whatling, Chief Clinical Officer for BT Health. He revisited the barriers to mainstreaming telehealth posited at the start by Professor James Barlow, and added some more:

  • A care model trapped in servicing high cost patients with existing conditions, rather than prevention
  • Silo budgets and services
  • Lack of organisational capacity and willingness
  • No clear agency to take the lead

He then observed a perception of less value for money as telehealth systems become more complex and costly. Customers for telehealth, he thought, are oriented to buying devices rather than services and outcomes. Suppliers are reinventing the wheel with competing systems which are not integrated into mainstream healthcare. He also noted the proliferation of closed systems and software, which leads to organisations being locked into particular devices and a lack of choice. This has particularly affected the ability of SMEs to compete in this market.

Would there be more take-up if costs were lower? Your correspondent pondered where all this was leading. The solution, it seems, is achieving economies of scale and re-using sunk costs in existing investments. These include existing IT systems under the NPfIT programme, out of hours services, and consumers/patients’ own investments in mobile phones, televisions, etc. Again, the unspoken question was being asked: are dedicated home health hubs necessary?

In conclusion, the presentations seemed to express confidence that some new models of service have got it right in establishing new ways of working in supporting patients at home, but doubted the wisdom of investments in dedicated health hub systems. These new models of patient support are up and working now, but the prospect of few or single multi-purpose information hubs in the home seem tantalisingly just out of reach in a possible future.


Tuesday afternoon, covering ‘Looking Local’ TV service from Kirklees Council. Reporter Steve Hards

Actually, it’s only ‘telecare and telehealth’ if you work with a very broad definition, i.e. giving localised health information via a dedicated channel on people’s TVs. However, the approach is interesting in that the channel can be delivered via a number of means: dedicated set top box; Sky box; Wii interface; Virgin cable.

The principle is simple. For a £12,000 annual licence (plus £3,000 content bureau cost if required) a provider council is set up with a basic ‘starter kit’ set up. There are various plugins that can be added, such as one that feeds local bus times; a jobs feed from JobCentrePlus; Council Tax payments; doctor appointments and repeat prescriptions.

More information:

There are 89 councils currently using the service. One workshop attendee made the point that many telecare customers are being discouraged by councils from taking up Sky and Virgin cable services owing to their incompatibility with their telecare equipment.

Reporter Steve Hards

Mike Piggott, Project manager BT, started by talking about the 21CN rollout and refinements introduced as a result of their pilot experience and working with TSA. One key point is that there have been no issues for telecare providers where they have been prepared. BT expects the change to be complete in 2011. Some devices – mostly over 8 years old – do not work well owing to transmission delays. There are published results for 159 devices: (Ambers = partial fails – talk to the manufacturers re the level of risk.) Lots of info re the migration on the site, additional queries can be sent to

Dave Foster, Commercial Director, Tynetec. The potential for system failure increases with complexity of the call routing, and telecare alarm calls are typically complex routes owing to the use of non-geographical (0800) numbers. Some non-BT digital network providers exclude reliable social operation on their networks… a user’s change of telecoms provider may put the operation of their system at risk.The new British standard BS8521 (pubished May 2009) defines the telecare protocols (the identifying signals generated by devices). The standard will facilitate interoperability between manufacturers and has some built in futureproofing. So any unit meeting this standard will communicate with the software of any monitoring centre that also complies. It’s an analogue protocol and a digital ‘IP’ protocol is in development.

Use of broadband opens up many greater possibilities for interactive monitoring communications but, of course, it will take quite some time to become universal.

Charles Henderson, consultant for TSA. Future consumers will demand telecare that is totally interoperable, flexible and cheap. UK providers have to work in the global context – Continua Alliance (not an open standards organisation), etc. And this has to be done in the context of providers’ delivery and installation processes. Who is going to arbitrate? The technology is the tip of the iceberg.


  • It’s not just about 21CN, but ‘Next Generation Networks’.
  • Manufacturers will not be able to cope to deliver new, standard-compliant devices if service providers wait until the last minute to update.
  • Current, IP-based systems may not comply with future IP protocols but standard-compliant analogue devices will continue to work over digital networks.

Workshop: SAFE AT HOME: Mental Health Intermediate Care, Herefordshire
Presenters: Andrew Morris, Integrated Commissioning; Cheryl Poole, Older People’s Mental Health Services; Jodie Thomas, Care Facilitator, Specialist Intermediate Care.
Reporter: PAUL MITCHELL, Independent Consultant

This joint initiative between the PCT and Council targeted people at home with dementia. Domiciliary care services in 2007 had lacked the skills to support people with dementia, and care packages were continually breaking down, resulting in admissions to institutional care. The solution was a partnership specialist intermediate care service which commissioned home support from specially trained domiciliary care staff (Sure Care).

The carer teams support individuals to regain or maintain their skills, but can intervene when risk levels rise to help prevent or manage a crisis. Using ‘Just Checking’ technology to track the patient’s movements around their home (motion sensors in rooms), roving night teams can access Just Checking reports on smart phones whilst on the move, and respond to alerts during a crisis. The presenters were keen to emphasise the collaborative approach with the care provider, whose staff are trained to help them to understand dementia and how to support individuals with such conditions.

A group of users were tracked for 12 months to dispel the myth, then prevalent amongst carers, that people with dementia cannot learn to manage their conditions.

  • 78% of the group were still living in the community after 6 months (57% at 12 months).
  • Only 5% needed 24 hours per week support at home
  • Over half received less than 7 hours support per week.
  • Costs of the service were £79k, with savings in excess of £100k over alternative services.

Lessons learnt included:

  • Partnership working is essential
  • Technology must be fully integrated with care processes
  • Care must be person-centred, individualised
  • All care staff must be equipped with specialist skills
  • Ethical approach: always act in the individual’s best interests where consent cannot be meaningfully given
  • Be flexible about the 6 weeks rule for intermediate care

Reporter FREDERIC LIEVENS, Med-e-Tel

The workshop started off with a short overview of Telecare in Barnet, where Guy is part of the two-person telecare team. They provide coordination, support, advice, guidance and training.

In Barnet, telecare training is standardly provided right across the board throughout the NHS, PCT’s, acute hospitals, OTs, specialist nurses, etc. So the assessment process can actually be done by any of them and they can, of course, refer back to the telecare team for assistance.

The telecare catalogue in Barnet consist of only two providers of lifeline services and two providers of stand alone systems. It’s a limited, but tried and tested offer, which seems to cover most of the needs. And if the offer does not suit a person’s particular needs, they will go off-catalogue to source other solutions.

The workshop then split up in four smaller discussion groups around two questions:

  • What makes for a good telecare assessment?
  • What information needs to be determined in the assessment?

The following suggestions and reflections came out of the discussions:

  • look at needs, environment and abilities/limitations of the person
  • assessor needs to have sufficient knowledge about available technolgies, how they work (through training)
  • ongoing assessment/reviews are necessary (is once a year – as stated in the TSA COP – enough?)
  • importance of informed choice
  • look at eligibility criteria
  • take into account previous assessments (eventually also non-telecare-related assessments)
  • think about risk management
  • use robust protocols

Main information that needs to be obtained is:

  • what equipment is available to serve specific needs
  • capacity of a person to operate equipment
  • what person can and can’t do
  • what outcomes are expected

For more info, contact and look at their website on (incl. An introduction to Telecare Services that takes people through some telecare basics, eligibility criteria and assessment procedures – Guy also has an interesting site at


home telehealth limited

Telecare Services Association Conference Tue 17 Nov 2009

November 16-18, 2009

Hilton London Metropole, W2 1JU

The cost of providing you with these reports has been supported by the conference organisers and
Home Telehealth Limited (UK)

home telehealth limited

Your reporter from this conference is Steve Hards

Tuesday 17 November

Contrast for today: pebbles and gems

Today was structured with plenary sessions in the morning with a round of workshops in the afternoon, and time to view the exhibition over lunch and between sessions.

The day started well with an opening address by Malcolm Fisk, Chair of TSA who flagged up an issue of particular interest to this reporter. That is, terminology in this field. He talked about the labels applied to the range of assistive technologies from spectacles, etc. to remote patient monitoring (RPM) and he suggested that ‘telecare’ could be used in a superordinate way to encompass the electronic technologies from pendant alarms to RPM. Whilst to many in the audience, used to thinking of ‘telecare’ as defining ‘smarter emergency alarms’ this may seem aberrant, the approach holds some interesting possibilities. If possible, further information will be posted in the Terminology section of this site to expand on the theme. Gem? Well, semi-precious stone at least.

For me, the next two sessions were pebbles. Tim Ellis, the Whole System Demonstrator Programme Manager for the Department of Health followed by Janice E Knoefel, Geriatrician in the Extended Care System of the New Mexico Veteran Health Care System, Department of Veterans Affairs. Maybe they covered what the majority of the audience (comprising people from a non-health background) needed to hear about telehealth but I suspect that the majority of Telecare Aware readers, hoping for some enlightenment and deeper insights than previously published in various places, would have been equally disappointed.

Most of the content of Tim Ellis’s session will be familiar. (If not, search Telecare Aware for WSD or start with this recent update on the WSDAN site.) He covered the history of the project and its problems and said that early results have been ‘very promising’. He also said that the results of the programme will feed into business cases but, having a dig at the equipment suppliers, said “the business case is easier to make if the equipment is cheaper.”

At the end of his presentation Tim showed an insipational video of telehealth in Newham. It does not yet seem to be available on their website, but there is one which you may want to watch, plus some Tunstall video case studies. You may also want to watch a BBC video of Tim Ellis demonstrating various telecare/telehealth technologies.

Janice Knoefel’s session was disappointing simply because her presentation slides were her reading notes. Her undulating tones and succession of difficult-to-read white text on blue slides were sporific. You may as well read them yourself, so, if possible, I will post a link to them if/when they become available. From the occasional asides, there were snippets: The VA has lots of care standards, but is driven by the bottom line – the more cost effective they are, the more veterans they can treat. Also, because they recognise that they cannot be all things to all patients, they target patients where they can have greatest effect on their care costs.

So where were the gems?

I confess I missed the following two plenary sessions (Working Smartly with Assistive Technology and Telecare, Clive Evers of the Alzheimer’s Society, and Digital Britain – the opportunities for telecare and telehealth providers and users, Richard Foggie, Department for Business, Innovation and Skills). My apologies if I missed two gems, but as one attendee remarked to me, the conference within the conference was going on in the exhibition area. It was certainly where most exchange of information, news and ideas was happening, and that’s where I did find some gems.

In no particular order they were:

a) The CareIP home telecare/telehealth hub, produced by Swedish company CareTech and marketed exclusively in the UK by Cirrus communications. The completely broadband-based system can connect devices to any call centre – always on, secure, and with no call costs.


b) The Everon system. Fast-to-install, easy-to-scale, fantastically reliable (thanks to its built-in protocols) wireless person monitoring and tracking. In the first year on sale in its native Finland it became the biggest-selling system in the care home market.

c) React Technologies’ implementation of the eye-catchingly small but sophisicated Ekahau tracking/tagging/two-button communication device. It can not only be used as a panic alarm but can be integrated into a whole network of ‘intelligent alerts’. For example, the system can be programed to ‘know’ when the last staff member leaves a building and can remind them to take certain actions.


d) The Novalarm (Verklizan Group) UMO system which has the potential to remove the need for fixed call centres, taking out a considerable overhead cost.

e) One gem I can’t show you yet because it isn’t properly launched in the UK. All I can say for the moment is that while nothing is perfect in the telecare world, the user-accepability of this tracking device will come pretty close. Pshaw!


Will post a section on the workshops tomorrow.

Putting a Fun point on it

The team from SupraUK, suppliers of key safes and other safe boxes to the UK’s telecare industry, and one of the main conference sponsors, always go out of their way to inform and entertain. This year they emphasised their theme of Saves Time, Saves Lives by decking out their stand with a Tardis, and themselves in Dr Who costumes. It’s a great marketing gimick in the best sense of the word, making what could be a pedestrian product into an instantly recognisable brand amongst the conference attendees.



Telecare Services Association Conference Mon 16 Nov 2009

November 16-18, 2009

Hilton London Metropole, W2 1JU

The cost of providing you with these reports has been supported by the conference organisers and
Home Telehealth Limited (UK)

home telehealth limited

Your reporter from this conference is Steve Hards

Mon 16 November: Afternoon

As I headed towards the conference venue I sensed it will be a conference of contrasts. The London November gloom is swept aside by a burst of sunshine as I pass a rain-soaked Hyde Park where the strewn leaves and twigs attest to last night’s poltergeist party. Moving up the Edgeware Road, and into the venue, the contrast is one of unordered bustle to well-ordered bustle. A lunch buffet is being served in the exhibition area where 40 companies are settling in and gearing up to greet, talk and demonstrate.

Next contrast – this high-tech conference has no free wi-fi. The twitterstream is going to be very quiet, I think.

The theme of the afterrnoon’s session – older people, carers, and their responses to technology. Carer, consumer, commissioner  …. consumers to be the commissioners in future? However, as Simon Roberts from Intel said, “There’s no Moore’s Law for culture change – it takes a lot longer and a lot more effort”

So it started with Dame Joan Blakewell, broadcaster, journalist and the UK Government’s ‘Voice of Older People’  (1st year report published today) reminding the audience what is is like to be old. Inside you feel the same, but the outside is letting you down, sending ‘wrong messages’ to people around. You resist, but technology is hard for older people and they don’t get it right. She identified a main issue as being how do we handle the 15 year transition from the current older people to a generation of older people who are comfortable with technology. She pointed out that “installation isn’t half the battle – it’s just the first step”.

Imelda Redmond CE Carers UK. (family carers/caregivers) Current care systems are based on underlying assumption that there will be a daughter nearby, ready to pick up the caring. In the UK the people who get services are getting better services than before, but fewer and fewer people qualify. Carers really benefit from telecare, and she chanenged the industry to focus less on social services and health commissioners as they are not flexible enough – there needs to be more input from mass market companies supermarkets and DIY stores, etc.

Dr Simon Roberts (an anthropologist and Intel’s lead for technology reseach for independent living). There is an inherent problem in the ways we construe older people as users of technology – often using ‘my mum’ as stand in for all mums. That is there’s no evidence, just assertion. It’s becoming increasingly meaningless to consider age as confering certain charateristics. Increasing use of Facebook and mobile phones by people over 65. (Intel  developed a touch screen phone as a research tool and – discovered that ‘simple’ quickly becomes ‘boring’. So his message was ‘Design for us not them’. Consider the technology’ s appeal – tactile qualities – display- desire… Design and deliver with soul.

Stephen Wey from York’s Centre for Assistive Technology and Enabling Environments (CEEAT) “Let’s talk telepartnerships rather than telecare.” Technology should bring the world closer, and ethical  considerations should be a help, not a hinderance.

David Behan Director General for Social Care, UK’s Department of Health. Talked about forthcoming changes int he UK’s system of social care, particularly the Personalisation Agenda (Google it) and what technology can contribute. The current system is not fit for the 21st century, There are lots of ideas on how to change it, but how will the changes be paid for?

Contrast of the day: Aspiration v Reality



News from exhibitors

HTL in China

Following from the Home Telehealth Limited press release, a photo of the HTL team with their Chinese hosts.


Tynetec contract in Scotland

Tynetec has announced a substantial contract with Scottish homes provider Trust Housing for the provision of eqipment and monitoring services. Press release. (PDF)











Telecare Soapbox: Are Partnership Agreements Stifling Innovation?

Paul Mitchell, an experienced consultant and troubleshooter in social care in the UK argues that partnership agreements between councils and telecare providers may be anti-competitive, anti-choice, and not in the best interests of service users.

Many social care authorities who have signed up to so-called exclusive ‘partnership’ agreements may now regret having their hands tied.

All is not lost however because unless those providers can live up to the implicit and explicit terms of those agreements I would urge the customers to review the validity of the agreements. First let’s look at some of the frequently recurring terms in such agreements and their implications. (more…)