Gary RaynorTelecare Development Manager

Telecare in Essex

Investment in telecare is also particularly attractive because: it is low-cost, lacks undesirable side-effects and is not disruptive of daily routines or intrusive in the home.

– Professor Sue Yeandle: Telecare; a crucial opportunity to help save our health and Social Care system (2009) http://www.bowgroup.org/content/telecare-crucial-opportunity-help-save-our-health-and-social-care-system

Scope

• Essex Pressures• Mainstreaming• Potential Savings• Case studies

• 1,300 square miles; a mix of urban and rural;

– three towns with populations over 100,000 – Basildon, Chelmsford and Colchester

– three-quarters of the land used for agriculture

– 300 miles of coastline– busy road and rail network; Stansted

airport; Harwich seaport– bordered by London, Hertfordshire,

Suffolk and Cambridge– 12 District Councils– 5 Primary Care Trusts

• Population 1.36 million• by 2021 over a quarter of the Essex

population will be over 65• The working age population is not

growing at the same rate– the ratio of working age adults to

over 65s is expected to drop by around a third (to about 2.5 per person)

• 131% (Nationally 110%) increase in over 85 year olds to 61,800

• More people are living alone and there will be more people without children to support them when they grow old

• User expectations are rising

Context - the County of Essex

Population Changes

General increase of 18% for all ages across Essex.61% increase in over 65 year olds to 483,000 (Nationally 53%)131% increase in over 85 year olds to 61,800 (Nationally 110%)(2004 – 2029 Figures)

Essex - 2006

8% 6% 4% 2% 0% 2% 4% 6% 8%

0-4 5-9

10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84

85+

Age

Gro

up

Percent of PopulationMales Females

Essex - 2030

8% 6% 4% 2% 0% 2% 4% 6% 8%

0-4 5-9

10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84

85+

Age

Gro

up

Percent of PopulationMales Females

Options

Run small scale pilot– Low cost– Easily monitored– Low resource– Low impact– Denies availability to

the greater population– Start again after trial

Create a Telecare Assessment Team

– Quick start– Dedicated Team– Concentration of

knowledge– High resource– Wider availability– Risk of growth in team

with demand– Dispersed– Loss of knowledge if

service then mainstreamed

Mainstream the Service– Believe what other

trials have shown – Low resource– Slow start– Support and train

all partners– Low cost– Wide availability

Set up

• Senior Manager Support! • Embed the Process• Partners

– Existing Infrastructure• Carelines (9 in Essex)

– Train them» Equipment» Techniques

– Logistics (Essex Equipment Service) • Specialist Installs• Demonstration facility(s)• Train the Assessors

Partners

Essex Eqt Service

Service UserCarelines

External Installers

Essex County Council

Specialist Installer

Carers

• There are six million carers in the UK looking after a family member, partner or friend – Unpaid carers save the country £87 billion a year.

• Staff sickness absence costs the UK over £12bn per year, – £495 per individual in direct costs employed (CBI 2005).

• 95% of carers regularly cover up or disguise that their health is suffering (Care UK 2007),

• One in five carers will leave employment as a result of their care responsibilities.

• It is projected that the number of people providing support to relatives or friends is set to rise to 1 in 4 by 2038.

Support

• Smart Homes

• Resource Folder, Flyer and Brochure

• Exhibitions

• Conference– Peer presentation of Case Studies

• Support Staff

Leontine HallSocial WorkerDevelopment Lead North

John CernySocial WorkerDevelopment Lead South

Holly WallsTelecare Assistant

Gary RaynorTelecare ServicesDevelopment Manager

• Newsletter– Internal– External

Process

Feedback

“Reasons” not to

• Perceptions– Not useful for my client

group– Less effective than

supposed– Responder Service– Not my role to persuade– Robustness of technology– Personal Care

• Barriers– Knowledge– Technical Issues– The Right Solution– Commissioning and

Ordering– Supply and Installation

Tele-tales

Costs and Benefits

• Commissioning based comparison of support costs– For all sample users

– £1 on Telecare is £3.58 saved in traditional care– For all sample users with savings

– £1 on Telecare is £12.60 saved• Savings accrue to following years• 09-10 total costs £338 per user for 6,822 users

No: of Service Users

No: with Careline

Connection

Cost of Equipment

Careline Support Savings Saving

Ratio

Overall Summary 240 143 £38,293.29 £14,928.00 £190,578.39 3.58

Children - - - - - -

Adults 18 5 £3,294.01 £532.00 £6,059.04 1.58

Older People 222 138 £34,999.28 £14,396.00 £184,519.35 3.74

Telehealth Activity12 12

7

4

23

0

2

4

6

8

10

12

14

Admisions A+E Visits

105

83

65

110

6457

0

20

40

60

80

100

120

GP Visits LTC Home Visits

Central Essex(3 Qtrs of Activity)

Prior Qtr

1st Qtr

2nd Qtr

Central Essex Community Services Careline Data

For more data and explanation please contact claire.aldridge@midessexpct.nhs.uk

Satisfaction with the Service• Overall 84% of carers and users are

satisfied with the service and satisfaction increases with time. QA Research 2010

78% 83% 88% 100%

0%

20%

40%

60%

80%

100%

3 mths 6 mths 9 mths 12 mths

Professor Yeandle again

• Time is not on our side in putting in place, across the country, an infrastructure of care and support equal to the challenges ahead. Bold action, committing resources now to technology, training, and the implementation of the simple, readily available, technologies already at our disposal - which are proven to reduce risk, sustain independence and support carers - has to make sense.

• It can be investment to save• It can eliminate common risks to health and wellbeing• It can enhance the quality of life• It should be a simple decision

A Brief History of Scurvy

• 1540 first remedy noted in Canada in the native population• 1617 the first use of lemon juice with the East India company• 1747 Royal Navy commenced “clinical” trials with oranges and lemons• 41 years later the RN implemented a general solution using lime juice

– Hence the use of the term Limeys!

•That’s 171 years from knowledge to implementation!

Gary RaynorCommunity Wellbeing Delivery Manager

Email: gary.raynor@essex.gov.ukMobile: 07748-623858

Case StudySupporting Choice of Tenure

• 98 year old lady whose family wanted to place her in residential care, advising that the lady left her door open and wandered.

• The lady did not want to go to residential or sheltered housing.• Commissioner installed a Just Checking system as a pre-assessment

tool.• This confirmed that the only times the door was opened was for carers,

her gardener visit and when she went to day care. It also showed that the door was not left open.

• This evidence supported the clinicians decision that the lady was not at risk. She remained in her home for another six months prior to her death.

• Possible saving of £11,700 in residential care avoidance• System Cost £688 with annual monitoring costs of £492, potential to

“hire” minimum 5 times a year = £144 per hire

Case StudySupporting Choice of Accommodation

• Mrs Y was placed in care home in Brighton. After a down turn in her function a review indicated the current accommodation could not meet her needs

• Options were – Move to alternative accommodation– Move to another, more expensive, room– Maintain current room with a means of alerting staff to bed or

room exit at night. The preferred choice of user and family.• Telecare package commissioned at £547 one off cost • Year one savings £1,953 pa

• Year two savings £2,500 pa

Case StudyResidential to Domestic Living

• Mrs T aged 85, was discharged to residential care after a stroke. After 4 months she became depressive and an assessment was conducted. With a small care package and telecare support she was returned home.

• Residential Care costs £23,500 pa• Care Package costs £9,720 pa• Telecare cost £420 one off• First year saving of £13,350 pa

• Second year £13,780 pa

Case StudyQuality of Life and Carer Support

• Mrs P is 77 and living in sheltered accommodation. The original concern was that she was forgetting to take her medication, but further investigation showed that some meals were being missed as well. The relationship between Mrs P and her principal carer, her daughter was deteriorating rapidly.

• Simple pill dispensers would not assist the meals prompting so a Mem-X was used with messages recorded by the daughter.

• The unit prompts for medication, inhaler and meals and the daughter has subsequently added other reminders such as appointments.

• Both are happy with the system• Cost to ECC £92

Case StudySafeguarding and Independence

• Ellen is in her fifties, living alone and has a learning disability

• Has experienced harassment and intimidation, leading to a safeguarding issue.

• Unable to contact anyone as she found telephones complicated and was adverse to technology, she declined a telecare bogus caller solution.

• Ellen accepted an Easy-5 phone, customised in accordance with her wishes, cost £149.

• The phone has been used to summon aid successfully and Ellen continues to live in her own home.

Case StudyResidential Care Avoidance

• Mrs A aged 74 lives alone is challenged by poor health, memory, mobility and is unrealistic as to her abilities. Three hospital admissions in 5 years arising from UTIs and a fall.

• The last discharge was to be to residential care, but with daughter’s support, Just Checking (under a Carer’s assessment) and Telecare were commissioned.

• Aug 07 – 7 hours care £4,790pa– Telecare Equipment (inc OT kit) £900 one off cost– Annual Saving v Residential Care = £16,809

• Aug 08 to 09 Annual Saving £17,709• Aug 09

– Care increased to £6,002– Annual Saving reduced to £16,498

• Cumulative saving to date = £68,725

Case StudySimple Reablement

• Mr P lives alone and is challenged by Parkinson’s disease. He has fallen at home on several occasions, some resulting in an hospital admission.

• On investigation the pattern of falls is related to transfers along a long corridor.

• A memory minder was commissioned with the simple message to “pick your feet up”.

• To date (from Dec 2009) no further falls have been evidenced

• Cost to ECC £16.40