1 Cabinet Member for Adult Social Care and Health ASCH04 (14/15) Commissioning of Telecare as part of wider Assistive Technology Services for West Sussex July 2014 Report by Director of Public Health and Social Care Commissioning Key Decision: Yes Part I: Electoral Division(s): n/a Executive Summary The County Council currently commissions a 13 week Telecare Service targeted at frail, elderly and vulnerable people living in their own homes in West Sussex. The aim of the service is to provide technology that optimises the individual s independence and enables them to continue to live in their own home within their own community. The service supports the avoidance of unscheduled admissions and helps facilitate early discharges from hospital. The current contract started in 2010, was extended in 2013 and is due to end in January It is jointly commissioned though a pooled budget by the County Council together with Coastal West Sussex Clinical Commissioning Group (CCG), Crawley CCG and Horsham and Mid Sussex CCG through a Partnership Arrangement under Section 75 of the NHS Act The current budget is 526,000 (70% West Sussex County Council to 30% CCG funding), but as a result of the expected growth in installations during the period of the new service, it is proposed to commission spending of up to 4.3m between 2015/16 and 2018/19. Over the next four years, the County Council faces significant demographic, legislative and strategic changes across health and social care. There is a strategic drive to promote wellbeing and independence and to support more people in their own home and community. The County Council is therefore looking to develop personalised and integrated services, which support independent living in the community, and which prevent or reduce admissions to hospitals and care homes. Assistive Technologies, including Telecare, is pivotal in supporting this strategic drive. This paper sets out a proposal to commission new Telecare arrangements from January 2015 as part of a wider approach to developing Assistive Technology. Recommendations The Cabinet Member for Adults Social Care and Health approves: 1. The commissioning of a countywide Telecare Service as detailed in paragraphs from January 2015, for a period of up to 4 years. 2. Funding of up to 4.3m from the County Council and Clinical Commissioning Groups for the 4 year term of the contract/s. Funding will only be used to meet demand and will be dependent on the solutions identified and agreed;
2 therefore the figure may be lower. 3. That authority is delegated to the Director of Public Health, Health and Social Care Commissioning to award contract/s to provide telecare services over the course of the 4 year term in line with the service specification. 1. Background and Context 1.1 Assistive Technology is any product or service designed to enable people to optimise their independence by supporting them to remain in their own home and community. Telecare is primarily the use of a product to enable support to be called, for example through a call centre, or accessed, for example enabling a neighbour to access the person s property, if someone faces an emergency or crisis. It also includes a range of other products to support people to have their social related needs met in their own homes. An individual may require Telecare alongside other technology and care or support as required, depending upon their personal circumstances. 1.2 The most recent figures from the Office of National Standards (ONS) give the 2012 mid-year population estimate for West Sussex as 815,100. The number of older people continues to increase at a higher rate than overall population change. Over 21% of the population (174,500) are now older people aged 65 and over. The number of people with a limiting long-term illness (LLTI) make up over 16% of the population. By 2026, on average these figures will have increased by 30%. 1.3 Approximately 84,400 people (10.5% of the county s population) said they were carers in the 2011 census. This includes carers who are providing 50+ hours unpaid care per week. The Care Act will require all Local Authorities to ensure that carers assessments are provided and comprehensive support is in place to meet the needs of unpaid carers. 1.4 Nationally, the potential benefits of Assistive Technologies have been recognised. The White paper Caring for our Future; Reforming care and support recognised the importance of Assistive Technology in supporting independence, noting in particular the value of home adaptations and Telecare and Telehealth services. 1.5 Locally, Telecare has been in development for many years, culminating in the current arrangements, where, in 2010 the County Council contracted with Wealden and Eastbourne Lifeline (WELbeing) for the provision of Telecare services as part of a jointly funded Telecare programme by WSCC and the three West Sussex Clinical Commissioning Groups (CCG s). The contract is funded by a pooled budget across health (30% of total value) and social care (70% of total value) through a Section 75 Partnership Arrangement to a value of 526,000 per annum. The contract is managed by the Directorate of Public Health, Health & Social Care Commissioning. Following an initial contract period of 3 years, in 2013 the contract was extended for a further period of 2 years and will end in January 2015.
3 1.6 In the current arrangements the installation costs and first 13 weeks rental for each individual referred to the service are paid for, so that the individual receives the initial service free of charge. Referrals are made by health or social care professionals and people receiving the service do not have to be eligible for social care services, either by nature of level of need or financial means. 1.7 After the first 13 weeks the individual can use their Personal Budget to continue with the services or, if they do not meet Adult Services eligibility criteria, can choose to become a private client of WELbeing or any other private provider of Assistive Technology, paying for any services from their own funds. If neither of these options is taken then the equipment will be removed. 1.8 Over the last 4 years installations in West Sussex have increased on average by 20% per year, and to date more than 9200 individuals have received Telecare services, keeping them safer in their own homes. 1.9 In addition, the County Council s 13 week Telecare Programme aims to support meeting joint social care and health targets of reducing admissions to hospital and supporting individuals earlier discharge from hospital. The programme also supports meeting the national target of maintaining peoples health and wellbeing for up to 13 weeks after discharge from hospital. 2. Review of Telecare 2.1 A benchmarking exercise was completed in August The research indicated that Telecare does or has the potential to deliver considerable savings in the following areas: Reduced domiciliary care costs (less/shorter visits). Reduced health costs by: o Reducing risk of falls. o Quicker emergency response times resulting in shorter treatment periods. o Earlier hospital discharges. Delayed admission to residential care by supporting people to stay in their own homes. 2.2 The conclusion of the benchmarking exercise was that investing in and promoting Telecare meets WSCC performance objectives and significantly helps towards meeting the requirements of the Adult Social Care Outcomes Framework. The main recommendation was that Telecare should be considered as a mainstream service and commissioned appropriately. 2.3 In early 2014, research was carried out to determine potential savings of the Telecare Programme for both health and social care. Both financial and nonfinancial benefits were identified through the research. The research suggested that: 43% of customers received Telecare services to facilitate early discharge from hospital. Telecare could be used to reduce the need for another type of care, in particular domiciliary care. Telecare, with additional support, could delay admission to a care home.
4 2.4 In West Sussex, a strategic review has been undertaken, including a benchmark report, which provides thorough analysis of all aspects of the present service including referrals, equipment and processes of the Telecare Programme. The results of the review suggest that significant benefits / savings can be made by utilising technologies and that further investment could multiply these benefits / savings. 2.5 A recent pilot study to examine the potential benefits of assistive technologies to carers showed very encouraging results in terms of reducing carer stress and in some circumstances are a viable alternative to at home respite. The provision of this to carers has been mainstreamed and is currently funded through the Carers budget. Exploration of the benefits of joining up the approach within the model specified are being considered, and where there are associated benefits, this will be incorporated. 3. Consultation Members 3.1 An informal presentation and briefing to the Health and Adult Social Care Select Committee was undertaken in May This outlined the current service, and explained the new model that was being proposed. Overall there was agreement from those members present that Telecare and in particular Telehealth would be beneficial for West Sussex residents. Clinical Commissioning Groups 3.2 Reports have been presented to the Joint Commissioning Strategy Group regarding the proposed model for the delivery of Telecare as part of Assistive Technology services. Following this, potential for a telehealth trial will be explored further with the CCGs and in the meantime the future telecare service should be developed for a service beyond January Providers 3.3 The existing provider is aware of the end date of the existing contract. In addition, consultation with providers in the wider market has incorporated discussions with District and Borough Councils as strategic partners and stakeholders and as providers of Telecare services across the County. Public 3.4 In August 2013 a survey of 100 post 13 week West Sussex Telecare users (private customers) was undertaken by WELbeing on behalf of WSCC. The headline findings were: 88% of users believe they now get more care and attention having the use of Telecare. 71% of users believe that Telecare has helped them in their daily life. 39% of users believe that the use of Telecare makes life easier for their carers. 3.5 The County Council s Annual Survey sent to Adult Services customers in January 2014 included 2 questions relating to Telecare. The intention was to assess the opportunity to consult with members of the public who already use Telecare but are not part of the County Council s 13 week Programme. 117 respondents had Telecare installed. 67 (57%) respondents thought
5 Telecare was extremely or very effective and a further 42 (36%) thought it was quite effective. 3.6 In addition, initial consultation with the customer and carer group has taken place, with the outcome that customers would be interested in being involved in developing and procuring arrangements for Assistive Technologies in the future. Further work to engage with the Adults Services Minority and Ethnic Communities Working Group is in hand. Internal - WSCC & NHS Staff 3.7 On 22 nd August 2013 a workshop was held to consider the future direction of the County s Telecare Service. The half day event was facilitated by PA Consulting and involved senior managers from both the County Council and Health teams that were interested in influencing the future Telecare service. It focused on what we were doing now, what we could do and the options available to get to that point. It concluded that: Telecare/Telehealth was here to stay; It had proved it could deliver real benefits qualitatively; West Sussex Health and Social Care challenges could not be addressed without it. 3.8 There are currently over 60 Telecare Champions who represent social care and health professionals that refer for Telecare, who meet quarterly and have been consulted on for example referral processes, the importance of Telecare and the implications if they were unable to utilise Telecare. 4. Proposals 4.1 The proposal is to develop a model for Assistive Technologies in three phases that may run concurrently but which will all be completed within the next 4 years. The proposal is to secure a contract/s for phase one streams 2 and 3. Future reports and consultation will address proposals for the further phases. Overarching aim 4.2 The overarching aim is to try to develop a culture where Assistive Technology is the primary consideration by members of the public and health and social care professionals, where appropriate, to meet preventative care and health needs and to provide an integrated personal approach to maintain and optimise independence. This will be achieved through increasing awareness of Assistive Technology internally through using the health and social care champions and externally to the wider public through working with stakeholders. Phase 1 - Telecare 4.3 The first phase will be to ensure the continuation of a telecare service in West Sussex following the end of the existing contract in January 2015 and develop a broad and flexible approach to the commissioning of Telecare services over the next 4 years. The model suggested has 3 streams to cover maximising the provision of technology by the wider public generally, to support people to optimise their independence and reduce their use of health and social care services, and to support people with urgent needs as a short term mechanism during or following periods of crisis, illness or injury.
6 4.4 The three streams include: Stream 1 - Awareness raising and wider promotion including commissioning support to provide proactive information and advice to the general public and signposting and utilising the market place within Connect to Support. This will involve working with providers, District and Borough Councils and other stakeholders, to publicise the telecare solutions and choices available and will enable potential customers to utilise this information to access and purchase the service Stream 2 - Prevention and intervention supporting people to remain independent in their own home and enabling them to reduce their use of health and social care services. Referrals will come from Prevention Assessment Teams, Proactive Care Teams and other health and social care professionals Stream 3 - Urgent or crisis need provision of Assistive Technologies within a short timescale, likely to be 24 hours, to support prompt discharge from hospital, support hospital admission avoidance and to support people if they have a short term urgent health or social care crisis. 4.5 Both streams 2 and 3 will be commissioned and provided on the basis that the Telecare service will be provided to all customers free, for a maximum of 13 weeks. Users of the Telecare service will then be able to use their Personal Budget, if eligible, to continue with their service or if not eligible may choose to purchase the service through a private arrangement with their provider. 4.6 It is intended that streams 2 and 3 will commence in January 2015, with stream 1 being a continual process and building on existing work around promotion, information and advice. Phase 2 - Telehealth 4.7 The second phase will be around researching and developing the evidence base around the benefits of Telehealth. There is a growing body of evidence which suggests that using Assistive Technologies for remote monitoring of certain health conditions can support people to self-care in their own home and community. Not only does this support the patient to optimise their independence but also provide benefits to the local health and social care economy through reducing emergency call outs and hospital admissions. Telehealth is not intended to stop all face to face contact by a health professional but will enable contact and visits to be managed by both parties to ensure that visits to GP s and hospitals are minimised. 4.8 It is planned that, during , if agreed with the CCG s, a trial of Telehealth will be undertaken to use evidence and experience gained to enable further consideration of the benefits and potential development of Telehealth.
7 Phase 3 Other technologies 4.9 Phase 3 will be looking at other forms of Assistive Technologies, for example the use of Apps and linking people via video conferencing through televisions, tablets or computers, to support Telecare and/or Telehealth provision, and an action plan would be developed around this area. 5. Other Options considered 5.1 One option considered is to continue to provide Telecare under the same specification and existing budget arrangements. However this will mean that increased use of Telecare may be limited and therefore the potential benefits of Assistive Technologies may be lost for both customers of health and care services. In addition, using the same model may not enable other potentially more efficient and/or effective models to be developed. 5.2 A further option is to provide services for people for longer than the 13 weeks. Concerns have been raised about customers not being able to fund services privately after the initial funded 13 week period. Information gathered suggests that the 13 weeks is beneficial for customers to explore the potential use of Telecare before making a decision on what equipment might be suitable. In addition the review highlighted that 70% of customers retain some aspect of the service, paid for privately following the 13 weeks, and a very small proportion express an inability to fund the service where this is expressed every effort has been made to seek alternative funding. Funding people for longer would reduce the numbers of people who can benefit from the service. 6. Resource Implications and Value for Money Value for money 6.1 Technology that supports a patient at home typically has benefits for both health and social care. Evidence from the West Sussex County Council review of its current Telecare Service suggests that there are both financial and non-financial benefits. 6.2 It is estimated that there are efficiencies associated with investment into the service which would extend beyond the cost of funding the service. Some of these will be cashable since they will result in an outright reduction in activity levels, for example by reducing admissions to A&E and residential care homes. Others will be non-cashable, such as domiciliary care because of the way this cost links into personal budgets, but may provide a lever to enable further savings to be realised over time. 6.3 The efficiencies are different for each individual depending on their circumstances, and there may be other costs related to supporting people at home, on top of the Telecare provided. 6.4 In addition there are non-tangible benefits for the users of Assistive Technology, through optimising independence and improved health and wellbeing. These will ultimately have a financial impact but this will be difficult to quantify.
8 Resource implications 6.5 Telecare is managed as a pooled budget. The level of provision in 2014/15 is 526,000, of which the County Council contributes 70% ( 368,000) and the CCGs 158,000 (30%). 6.6 Based on current use of the contract and including the effects in the next 4 years of the plans to extend arrangements as identified in this paper, it is anticipated that the number of users of Telecare will increase. The Telecare forecast installation numbers below are based on an average increase in installations from the last two years of the current contract. The number of installations will depend on the level of demand, the level of funding commitment, and the ability of referrers to promote the use of technology as part of a proactive support mechanism. 6.7 There are a number of models that could be proposed to deliver the service, and in assessing these it will be important to consider both the price of the arrangements and the ability of models to deliver the service benefits we are expecting. There is also potential variability because spend in each year will be dependent upon demand for the services. For these reasons, defining the actual funding requirement is not straightforward. However, using information from the current contract provision, and allowing 25,000 for publicity as part of stream 1, 4.4m is an estimated maximum amount for the term of the arrangements to meet the forecast installation numbers highlighted above. This splits between individual financial years as follows:. 2015/ / / /2019 TOTAL Funding required 825, ,000 1,165,000 1,385,000 4,360,000 Current provision of which County Council CCGs Potential maximum Increase in investment 526, , , ,000 2,104, , , , , , , , ,000 1,472, , , , , ,000 2,256,000
9 6.8 In the first instance, the County Council and CCGs have agreed that the additional funding needed will be charged against the Better Care Fund. However, based on the returns achieved by the current Telecare contract, the expectation is that this will release savings in other areas of both partners budgets at a level which will mean that the investment more than pays for itself. In the County Council s case, these will help deliver its savings targets from promoting independence. For the CCGs the outcome should contribute towards a reduction in acute hospital expenditure. 7. Impact of the proposal 7.1 The impact of the proposal is that potentially more people will be introduced to and use telecare in the future and will therefore be supported to optimise their independence and remain in their own community. In addition the increase in use of telecare will support system wide longer term planning in respect of hospital discharge, admission avoidance and meeting short term health or social care crisis. 7.2 A further impact is a potential change in provider. However, the impact of this for customers is small, as customers are only funded under contract arrangements for 13 weeks. They would therefore continue the 13 week period with the existing provider, and new customers would be supported under new arrangements. 7.3 The new arrangements will hopefully enable individuals to have information advice and choice in the provision of services and would also hope to lead to greater efficiencies. 7.4 In terms of the impact for resources and process, new arrangements will require clear communication, processes and procedures and transition arrangements. These will be planned as part of the mobilisation period for the new arrangements from January Equality Duty 8.1 With the continuation of Telecare under a model of provision including a 13 week free service provided to people irrespective of whether they are eligible for services or not, it is not expected that there will be negative impacts on customers with protected characteristics. Technology services can be used to assist individuals who are vulnerable to discrimination, harassment and victimisation, in a person centred specific way once such individual risks have been identified and shared with the provider, and hence could support people with protected characteristics. 8.2 Service providers will be expected to meet Equality legislation and ensure that recruitment and staff development processes reflect the same level of equality for people with protected characteristics. Providers will be required to create and maintain records about the customers supported through the installation and monitoring of equipment, and the equipment installed, which will be reviewed regularly as part of contract review processes. In addition through providing training and development opportunities, providers will be
10 expected to encourage and communicate to their staff that there is an expectation of equality of service for all customers, particularly for people with protected characteristics. 9.0 Social Value 9.1 Access to the service is not means tested and is available to all residents of West Sussex regardless of their characteristic or where they live. 9.2 An aspect of the existing arrangements which presents social value, and hence would need to be specified and reflected in new arrangements, is the employment of installers that live and work in West Sussex and spread across West Sussex, which helps to minimise the impact on the environment by driving shorter distances. This also benefits the customer as response times are shorter in an emergency. 9.3 The future arrangements will look to support the local economy and local business by promoting the use of a range of locally provided Assistive Technology services, particularly through the Connect to Support market place and as part of stream 1 identified in This promotion and advertisement will support local providers to develop their market and extend their services to a wider range of people. 10. Risk Management Implications 10.1 If the service cannot be commissioned, the risk is that there will be a system impact, resulting in increased hospital admission, longer periods of time in hospital, increased numbers into residential homes and loss of individuals independence. National and local statistics provide substantial evidence that technology can save costs whilst also meeting the individuals choice to live independently at home In addition a risk to investing in equipment, without paying due attention to the strategic focus, and the training and education required to enable it to be used in an appropriate and informed way, will have an impact on the benefits seen. Health and social care professionals will need to automatically consider Assistive Technology as the first type of support to be considered when supporting an individual to stay at home There are technical risks, in relation to access to computers and technology to enable referrals for technology as part of the personalised care package, and to the ability of technology to be interoperable across health and social care systems A further risk is that referrals for technology do not increase as expected. This will be mitigated through the training and development element of an Assistive Technology service to health and social care professionals, through promotion to the public and through referring further targeted individuals identified by the risk stratification tools. There is no funding risk as funds will only be released to meet demand.
11 10.5 As outlined in 6.8, the plan is to source the additional expenditure required to meet the anticipated increase in installations through the Better Care Fund, but in respect of the risk that this funding is not forthcoming, to mitigate the risk of not having a service in West Sussex, the current levels of funding would be utilised to enable a continuation of telecare Lastly, a risk regarding the investment in Assistive Technologies is that it doesn t deliver the efficiencies estimated, or that these savings are not possible to re-direct. Key performance indicators to measure performance under future arrangements will monitor this closely. 11. Crime and Disorder Act Implications None. 12. Human Rights Act Implications None. Judith Wright Director of Public Health and Social Care Commissioning Martin Parker Head of Integrated Adult Care Commissioning
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