To receive a presentation from the Council’s Adult Services on the use of telecare to help prevent avoidable admissions to hospital from vulnerable people with long term medical conditions.
Minutes:
The Panel received evidence from Lesley Prince and Paulette Blake from the Council’s Community Alarm Service and David Souter from Tunstall
The Panel noted that the Service had been supporting elderly and vulnerable people in the Borough since the 1980’s. This was done by monitoring emergency calls via a warden’s call out system for people living in Supported Housing and dispersed units for people living in their own homes. It has expanded over the years and currently supported up to 4500 people within Haringey.
Following improvements in information technology, the government set up the Preventative Technology Grant scheme to expand services that were provided. This was done in order to encourage the greater use of such technology and create greater links between local authority social service departments and other organisations and individuals that support individuals, such as occupational therapists, integrated care teams, home care agencies, Housing Association supported housing officers, district nurses, community matrons and GP’s.
In Haringey, people were now considered for telecare as part of assessments that had been undertaken in response to referrals. The scheme aimed to;
· Reduce hospital admissions and readmissions
· Reduce dependence on care services and families
· Provide security in the home and enable greater independence.
· Reduce anxiety
· Improve the quality of life for patients and informal carers
· Delay the move into long-term residential care.
The basic systems just involved a button that was carried around the neck and could be pushed by clients in the event of an emergency. This was connected to a telephone line and would alert relevant staff. There were also a range of other sensors such as ones that detected movement, flood, carbon monoxide, falls, property exit and epilepsy. The equipment was battery operated and did not require hard wiring. It provided a warning to the control room when batteries were low.
Door exit sensors were particularly effective for individuals with increasing dementia, which could be exacerbated when they were removed from home into residential care. The sensor monitored when the client left the home. If and when they did, a call was generated and received in the Control Room, where appropriate action was taken.
The funding that was allocated to local authorities from the Preventative Technology Grant was generally intended for the purchase of equipment. However, it was important for the applications to be supported by appropriate staff. Haringey’s system was backed up by a call centre that was covered around the clock and based at Woodside House on Wood Green High Road. There was also a response service which ensured that calls were acted upon. Some local authorities had installed systems but did not have the support systems to respond effectively to calls.
The basic cost to the client was £5.95 per week for the alarm on its own. Additional items were charged at 50p. per two items. Each local authority had its own way of charging. The service tried to keep the cost low and had taken advice on fair charging. In addition to direct benefits to the individual, the sensors could help give carers and relatives peace of mind.
The service had also set up a pilot scheme in partnership with Primary Care Trust involving the use of Vivatech Wrist Care. This entailed the individual wearing a wrist alarm, which sent wellness data via the internet to Vivatech. This was passed onto community matrons. Community matrons were able to assess a range a data including sleep patterns and well being, which was measured by the patient’s circadian rhythm. As the patient’s level of health improved, the patient was moved off wrist care and assessed by the Community Alarm service for Telecare products such as a pendant alarm, fall detector, medication dispenser etc.
The Panel noted that considerable savings could be made as a result of the use of the equipment. For example:
Case History 1
Mrs R had been taken to hospital 4 of times at a cost of £400 for ambulance calls. She also had a high level of dependency on her sister, who had to travel from Brighton to take her out. When Mrs R was given a wrist alarm and Community Matron input, she began to go out every day, after notifying the control room of her movements. The knowledge that help was never far away increased her confidence and independence. There was a reduction of hospital admissions to zero over a 6 month period. The Community Matron was able to utilise the data and spot the start of urinary tract infection early enough to prescribe antibiotics and avoid hospital admission. It reduced the number of journeys that her sister made. In fact, the roles were reversed and her sister was admitted into hospital with Mrs R visiting her in Brighton.
The cost savings were as follows:
4 Ambulance calls £404.00
- cost of alarm for 6 months £154.86
= £250.86
- Cost of wrist data 25 x 6 £150.00
Saving of £100.86
Case history 2
Mrs L had COPD and heart failure. She had had 6 hospital admissions over a year at a cost of 3518 x 6 = 21,102. In the 6 months prior to wrist care installation she had 3 admissions to hospital at a cost of £10,051. In the 6 months since having the wrist care alarm, there had been no admissions to hospital and a reduction in the number of community matron visits.
Cost savings:
9 Community Matron Visits at £50 per visit = £450
Wrist care alarm and wellness data = £304.86
Total cost over 6 months = £754.86
Savings to the Primary Care Trust = £9296.14
The service was currently in the process of launching another tele heath scheme called Doc@home. This was a portable device which was left in peoples homes for a minimum of 3 months. It could ask the patient specific questions about their health and take readings of blood oxygen levels, ECG, weight, pulse and blood pressure. The data could be monitored via the internet. If a patient’s health was deteriorating, it could produce alerts that could be picked up and acted upon by community matrons. Doc@home could be used alongside a telecare alarm so that urgent emergency alerts could be made when necessary. Using the doc@home helped to educate the patient to take responsibility for monitoring their health and carrying out healthy practices such as eating healthily and reducing smoking and consumption of alcohol. Studies had shown very good results and reduced hospital admissions. The scheme was being undertaken in partnership with the Primary Care Trust and was aimed particularly at high intensity users, such as people suffering with COPD. In addition to reducing the number of visits to the hospital, it also reduced anxiety. Doc@home had been tested in several EU countries as well as 15 PCTs. It was initially being used with 30 patients.
The range of Telecare installations had been publicised via the following:
· Road shows
· Demonstrations
· A fall detector pilot study with Housing Association residents
· Demonstrations to all teams within Adult Services and occupational Health teams in the Whittington and North Middlesex Hospitals
· Attending events such as mental health, disability and carer’s forums.
· An open day at the civic centre
· Smart leafleting, utilising the census to target where the pockets of elders reside in the community.
· Linking with Haringey Residential Housing Associations.
The Panel noted that the cost of emergency care was as follows;
· Accident and emergency attendance: £101
· Cost of ambulance: £100
· Hospital admission £3,518
People generally adapted well to using telecare equipment. Clients were provided with guidance when the equipment was installed. The bulk of call-outs were false alarms but they were happy to receive them. Support staff were all fully trained and subject to Protection of Vulnerable People (POVA) checks. There was a strong care aspect to their work. The service was managed by the Adult Services Directorate. There was a feedback loop that enabled additional needs to be identified.
Ms. Thomas reported that wellness data could be of considerable benefit to health professionals. For example, sensors could detect whether people had had a restless night. Community matrons could access this data via the net and pick up the possibility of patients having a Urinary Tract Infection (UTI). It had therefore been of great benefit.
The service saved the NHS money by reducing the need for hospitalisation. The income that the team received did not cover the cost of providing the service. The service generated money from a range of sources, including Housing Associations and Supporting People. However, this did not cover all the costs and it was often challenging making up the shortfall. It was noted the service had a good relationship with the PCT. The PCT was currently in a relatively strong financial position and discussions were taking place on how financial resources from the TPCT could be used to support social care activities, such as this, undertaken by the Council that had the potential to make savings for the TPCT. The Panel noted that the cost could deter some people from having the equipment. People who were on certain benefits could get help with the cost. If people were referred, the service was free.