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…

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

Workshop: DEVELOPING A TELEHEALTH SERVICE

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.

Workshop: TELLYCARE – DELIVERING TELECARE AND TELEHEALTH VIA TV

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: http://www.lookinglocal.gov.uk

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.

Workshop: PROTOCOLS – FROM VISION TO REALITY
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: http://www.switchedonuk.org. (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 cpe21@bt.com.

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.

Conclusions

• 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

Workshop: TELECARE ASSESSMENT
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 telecare@barnet.gov.uk and look at their website on http://www.barnet.gov.uk/telecare (incl. An introduction to Telecare Services that takes people through some telecare basics, eligibility criteria and assessment procedures – http://www.barnet.gov.uk/telecare-booklet-2008.pdf). Guy also has an interesting site at http://www.smartthinking.ukideas.com.