Telecare

Telecare — from pilot to practice  

The hard benefits of telecare have been proven time and again. So how, asks Dr Beverly Castleton, can we bring it into the mainstream so those who need it can benefit?  

The Government’s recent White Paper Our health, our care, our say set out a vision for health- and socialcare services to create joint initiatives that support wellbeing and independence for older and vulnerable people.

A key focus of the paper was on transforming models of care away from reactive, 10-minute GP consultations and towards an ongoing, proactive care programme delivered by a care team and supported by telecare and telehealth solutions.

There’s no doubt that telecare can help older, vulnerable people to live safely and securely at home for longer and reduce admissions to residential care homes and hospitals. Government support for the technology is backed up by hard evidence from projects across the UK that have underlined the benefits of telecare time and again.

These projects cover a broad range of assistive technology, from simple safety and security devices such as flood and smoke detectors, fall detectors and emergency pendants for older people, through to more advanced technologies such as monitoring of vital-signs for those with long-term conditions. The need for remodelling So why isn’t telecare already in the mainstream? I believe the real issue is that the current care pathways are simply not ready to handle the administration of telecare on a community-wide basis.

What is needed is a different approach that includes an option for providing telecare assessments from the outset as part of the Single Assessment Process (SAP), so that its benefits can be brought to more patients. This in turn raises several key questions. How should the team of health- and socialcare professionals and services be assembled to deliver telecare to patients, and who should be involved? How is the need for a telecare prescription assessed, and how should the teams manage the telecare prescription process and response?

The good news is that answering these questions need not involve a major systems overhaul. It requires instead a means of tapping into existing systems, with clear planning and interdisciplinary co-ordination, to deliver an effective method of management.

Here I describe the process we have established in North Surrey PCT, including the recent involvement of Walton-on-Thames Community Hospital, which is proving successful in putting telecare into the mainstream delivery.

The Columba Project: defining the process The roots of the process model we are using are based on the Columba Project for Independent Living through Telecare, a collaboration between Surrey Social Services, North Surrey PCT, Runnymede Borough Council Careline and telecare specialist Tunstall.

This project has successfully used telecare to help people with intermediate care needs stay in their homes and avoid admission to residential care.

There were two key elements in Columba’s success. The first was the use of the intermediate-care team for assessing patient needs. The second was equipping a dedicated short-term residential unit with a range of telecare equipment, to familiarise patients with the technology and help to revitalise them. This also had the useful function of enabling staff to familiarise themselves with telecare delivery options.

After a brief period in the unit (typically four to six weeks), over two-thirds of patients were able to return to their homes and live independently, supported by homecare supplemented by a prescribed telecare package. The unit saw 22 completed patient episodes with 15 patients resettled at home with telecare support. The Columba Project was key in helping to remodel our working practices. It defined who should be involved, and helped to develop a care pathway for patient assessment and ongoing care. We are now applying the lessons learnt from Columba to mainstream telecare deployment across North Surrey for even more dependent people — and I believe other PCTs and councils can also benefit from our experience.

Working together

As the Columba Project showed the importance of assembling the right multidisciplinary teams to help streamline processes such as assessment, information sharing, escalation and management, we now have three groups at North Surrey PCT: the Intermediate Care Team, the Hospital Group and the Community Group.

The Hospital Group comprises a doctor, clinical officer, occupational therapist, physiotherapist, ward nurses and social services, meeting just once a week for around 90 minutes to discuss both new and current inpatients’ progress and needs. In effect, this group devises the rehabilitation programme which includes the possibility of a telecare prescription on discharge. The Community Group includes membership from a wide number of agencies, including senior social service managers, care managers, borough council representatives, a member of the mental health team, manageriallevel representatives from housing trusts, district nurses, community matrons and the co-ordinator of the rehabilitation team; a manager from the ambulance service attends some meetings.

Highly complex cases are referred to this forum, which meets fortnightly for one to two hours to discuss emerging patient needs. This highlights the requirement for a new or updated telecare prescription, based on further assessment of the patient. A manager from the communityalarms service, who has expert knowledge in telecare delivery, advises on the options available. The link between these groups is the therapist, who ensures the issues that are raised are shared. This group structure delivers the pan-organisation workflow and structure to manage the process closely for frail elderly people who have multiple needs.

At home with telecare

The second key lesson from Columba was to be able to assess patients’ needs in a telecaresupported environment, so the need for a telecare prescription could be verified, developed and tested with the patient before applying it in the home. To this end, a special four-bed unit equipped with advanced telecare solutions which will help monitor patients’ activity, including bed occupancy and movement sensors, is being installed at Walton-on-Thames Community Hospital. This is supported by preventive technology grant (PTG) funding. Installation of other equipment, for assessing patients with chronic heart and lung conditions, is also planned. A community hospital environment was chosen to avoid unnecessary stress for patients and give a calmer rehabilitation setting compared with a busy acute ward. We expect to be able to prescribe telecare for up to 32 patients per year.

An enhanced pathway for care

With the right teams, assessment facilities and solutions in place, the pathway for telecare deployment then becomes:

• identification of patients’ emerging need for telecare, through direct feedback from the Community Group representatives;
• assessment by the Hospital Group in the interim telecare facility or by the Intermediate Care Team in the patient’s home;
• development of an appropriate telecare package for patient and carer;
• prescription of this telecare package and development of a response protocol;
• a survey of patient’s home to ensure the prescription is appropriate;
• provision and installation of telecare equipment;
• ongoing monitoring and assessment of any calls; and
• regular reviews of the status of the care package by the professionals involved in the fields that can be fed back to the main groups if further assessment and revision of care is required.

I believe our work in North Surrey has begun to show how telecare can be brought into the mainstream of care delivery and applied community-wide, taking the technology from pilot to practice, and improving the quality of life for those that use it.

Dr Beverly Castleton is Associate Medical Director for North Surrey PCT.