Long Term Conditions Whole System Demonstrators

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Long Term Conditions Whole System Demonstrators

• Tim Ellis/Claire Whittington
• Department of Health

CSIP - Outcomes from Telecare and Advanced
Assistive Technology
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Session Aims

• Overall context
• Background to WSDs
• Lessons so far
• Next steps

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(No Transcript)
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Stronger voice for individuals
communities Increased support for self
care Service users and carers have more say
person-centred care planning Integrated health
and social care services Clinicians driving
improvement Renewed LTC focus
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White Paper Commitment Whole System
Demonstrators
WSDs will explore the exciting possibilities
opened up by truly integrated health and social
care working supported by advanced assistive
technologies such as telehealth and telecare.

• The objectives of the demonstrators are to
• Improve the care co-ordination of those with
  complex health and social care needs through use
  of an integrated health and social care system
  including joint health and social care teams
  using shared information to benefit systematic
  chronic disease management programmes
• Place a strong emphasis on patient education and
  empowerment, so that people are fully informed
  about their condition and are better able to
  manage it
• Provide health and social care commissioners with
  the right incentives to deliver better care for
  those with complex needs
• Involve the use of assistive technology
  (telehealth and telecare) in order to improve the
  health and well being of the individuals and
  achieve efficiencies in service delivery.

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Demonstrator Profile
Ivan Lewis MP Parliamentary Under-Secretary of
State for Care Services
Ann Keen MP Parliamentary Under Secretary of
State for Health Services.
Cross Government Interest, Professional Bodies
Interest, OGC reviews
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Selecting the WSD Sites
NEWHAM
KENT
CORNWALL

• The poorest County in England, with a dispersed
  rural population
• Population of gt500,000
• 46 of the population live in settlements of
  lt3,000 people
• 99.1 White British
• 10.3 of the population are aged 65 7.2 75
  and 2.6 85
• 21 of the population report a limiting long term
  illness

• One of the most deprived areas in the UK
• Population of 270,442 - GP registered population
  of 300,000
• Population increasing at a higher rate than the
  London average
• 2nd most diverse population in the UK - gt68 BME
  gt140 first languages
• 8.5 of the population are aged 65
• 17.3 of the population have a limiting long term
  illness
• Highest death rate from stroke and COPD
• Highest diabetes rate in the UK
• 2nd highest CHD rate in London

• Combination of rural and urban populations
• Population of 1.37m (excluding Medway UA). Two
  areas already piloting telehealth Ashford /
  Shepway population of 211,100 Dartford /
  Gravesham / Swanley population of 210,000
• 3.5 BME
• 17.3 of the population are aged 65 8.4 75
  and 2.2 85
• Within the target population, individuals report
  having an average of 1.6 of the three target
  conditions of HF, COPD, Diabetes

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Demonstrator Target Population

• We are planning to focus on over 7500 service
  users across the 3 sites

• Individuals with health care needs of any age who
  are at risk of current or future hospital
  admission, due to at least one of the following
  conditions heart failure, COPD or diabetes.

• Individuals with social care needs aged 18 and
  over

• Individuals with both health and social care
  needs as defined above.

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WSDs Key Elements
Telehealth
Telecare
Integrated health social care teams
Population stratification
Service Users/Clients/Patients
Appropriate assessment
Integrated health social care information
Partnership working housing, 3rd independent
sector
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WSDs what its not about !
Thanks to the smarter home, a home help is
required only twice a year- to adjust the clock!
Reference Bruno von Niman, GSC10 _at_ ETSI, Sophia
Antipolis, France Health-, care- and mobile
e-services
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WSD OutcomesProving the Business Case

• The demonstrators will lead to a better
  understanding of the level of benefit associated
  with telehealth and telecare in an integrated
  health and social care environment.
• They will also help fast track future change by
  addressing the key implementation barriers and
  providing solutions for the wider NHS and Social
  Care.

• We will know to what extent the WSD model of
  care
• promotes individuals long term well-being and
  independence
• improves individuals and their carers quality of
  life
• improves the working lives of staff
• is more cost effective
• is more clinically effective
• provides an evidence base for future care and
  technology models.

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Demonstrator Evaluation
Coordinator role (Birmingham )
Quantitative
Qualitative

• Service utilisation
• Impact on costs
• Clinical measures and patient reported quality of
  life
• Mechanisms of impact on service user outcomes and
  variations between subgroups

• Patient, carer and professional experience
• Organisational context and implementation process

Kings Fund, LSE, UCL, Oxford
Manchester, Oxford, Imperial
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Learning so far

• Understand your population
• Plan in advance and recognise the environment
  will change over the life of your programme
• Clearly define the whole integrated pathway
  requirements involve all the key stakeholders
• Ensure you have the right resources
• Ensure you can measure the benefit in a way that
  satisfies the needs of your key stakeholders
• Employ rigorous programme/project management

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Learning to inform wider implementation

• Through
• Promoting more user focused care and improving
  the information available to service users
• Facilitating introduction of integrated care
  pathways including telehealth and telecare by
  providing the business case for their
  effectiveness
• Encouraging research into the areas that
  currently provide a barrier to more widespread
  implementation through the Assisted Living
  Innovation Platform
• Guiding the development of integrated health and
  social care information sources based on national
  standards through our work with CfH
• Scoping the requirements for future procurement
  solutions for assisted living with PASA
• Sharing lessons learned by the demonstrator sites
  through CSIP

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Adding life to years and years to life
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Thank you