Joining Up Telehealth, Telecare and Tecnology Enabled Care
Within Gloucestershire we have many silo’ed services that all have the joint aim of increasing independence, mobility and safety within the home and community. We want to join these up to not only improve the outcomes of the individuals through the shared learning of each service but also remove the duplication within the system providing a better service to the individual and to provide a more cost effective model.
Currently we are piloting Technology Enabled Care within Social Care (through Gloucestershire County Council) as well as Telehealth within Health (through Gloucestershire Clinical Commissioning Group). We want to assess and compare these two pilots to see the impact that either of these initiatives has on primary care, secondary care or social care services, with the intention of proving that prevention is key to reducing demand on these services.
We then intend to join both of these pilots into our existing services – Gloucestershire Equipment and Technology Service. This should increase the platforms that are available to our prescribers, increase the solutions available to promote independence and embed both Telehealth and TEC into both health and social care provision in a preventative manner.
A further workshop with staff (following the initial discovery workshops) will be planned to engage with frontline health and social care staff across organisations to demonstrate Telehealth, TEC and GETS, identify unmet need, understand priorities and plan for a more joined up working.
This will lead to a revised GETS model that incorporates; Community Equipment, Telecare, Adaptations, Telehealth and Technology Enabled Care. The revised model will feature a single point of entry, better handover/offs between teams, step up step down processes and a model that is centred up to the point of prescription, order placement and then delivery and fitting in a more cohesive way.
All orders for these joint services going forward will be requested through our joint GETS database, this will allow a better understanding of the needs and equipment issued. Reports can be drawn down to analyse trends and effectiveness. One element we want to include in our soon to be updated database is a clinical decision tree; this could be for any area already mention in addition to the more traditional use to help select community equipment i.e. beds.
Joint overarching principles have been agreed but joint outcomes and outputs will be developed, this will be monitored through our Strategic Equipment Partnership. This project will be incorporated into the Strategic Equipment Partnership as well as our Integrated Community Equipment Service Partnership board for governance and ratification of decisions – both are attended by health, social care and housing colleagues.
Due to our equipment stores being in house it would be our intention to have in-house management of this project, this will allow for a joined up approach, closer work and will allow us to reflect the changes made in the one area to the other. Additional capacity will be needed for this.
We shall develop both a business case and benefits case to show the realised outcomes and savings that this solution has generated.
A user research report will be undertaken with both prescribers (health and social care) as well as service users, justifying the model, access and providers selected.
Our developed service model will show others how to implement as well as the learning found from undertaking this project and will be written into a set of instructions to share.
The conclusion will show us how to implement this design as business as usual, there may be a need for a beta project to fully embed within services or to roll out further as our learning may show.
Our mapping work and dip sample completed during the Discovery phase demonstrated a number of opportunities for efficiencies for the local authority, with opportunities for significant benefits for Adult Social Care . By joining these services we will realise the following benefits for the local government sector:
- By improving our ‘GETS’ offer, we aim to invest more in independence, keeping people in their own homes for longer and using equipment and technology to prevent, reduce and delay needs. This will reduce the amount that is spent on more expensive ‘third tier’ social care needs, reduce the number of primary and secondary care visits, and enable more people to be in control of their own care and support
- Emerging technology can increase opportunity for personalised care and support packages with advanced data and monitoring systems, so that support planners and carers may tailor support around an individual and changes in need can be adjusted to quickly
- Reduce duplicated assessments, home visits, installations and maintenance visits relating to technology. This will improve staff productivity in these jointly funded services, reduce waiting lists that may exacerbate needs, and increase the number of individuals who can receive the equipment they need in a timely manner
- Improve data transfers at every level – this means that customers will not need to give our the same information repeatedly, that services can work more effectively together, fewer items will be ‘lost’ and our understand of the beginning to end customer journey will be improved
- Realise efficiency savings in each services
The discovery phase combined three elements: firstly a research project that aimed to increase understanding of our current telecare, community equipment and telehealth services. We created a map of each service, including data transfers, hand-offs and interaction between services. Alongside this, we completed a comprehensive dip sample into the experiences of 50 service users who had been through one or more of the services. This work demonstrated a high level of duplication, hand-offs, inconsistencies of service, and opportunities for more joined-up working that would both create efficiency and improve the service user experience. For example most service users in the system currently receive multiple deliveries of equipment and technology in a year and interact with more than one service in the system – 73%. Many users found engaging with these distinct but overlapping service confusing.
Secondly, we carried out a project to explore the introduction of technology-enabled care (TEC) to expand our current telecare offer. This part of the discovery phase involved engaging with frontline staff to understand the unmet need for technology in Gloucestershire and identify gaps that could be filled with innovative TEC. This work will result in 2 – 4 pilots of new digital TEC products, to be delivered as part of our telecare offer, during the Alpha phase.
Thirdly, we began a pilot to increase and improve the use of Telehealth in the county, as it had previously been underutilised and was not valued by clinicians. Working with the provider, the pilot has already begun to explore the use of Telehealth equipment for a wider range of health conditions and in different settings.
These three pieces of work combined demonstrated huge potential for joined up working between the three services, as explained in the project statement.
During the Alpha phase we are committed to working with a number of partners across Gloucestershire: a key aim of the project is to increase and improve joined-up working and provide a single service for all equipment and technology in the county. Partners include: Gloucestershire County Council, Gloucestershire CCG, Gloucestershire Fire and Rescue Service (who carry out Safe and Well checks and act as a first responder for the most vulnerable individuals), Gloucestershire Care Services, District Councils (from a housing adaptations perspective).
We will commit to attend regular learning events with other local authorities and engage in online forums, to share the results of our project as they appear. The outcome of the project will demonstrate the feasibility and effectiveness of combining all technology services into a single unified service. We will share both qualitative and quantitative data on the project, including efficiencies gained and case studies of individuals who have been through the service. We will also share our redesigned delivery model at the end of the Alpha phase with any local authorities considering a similar approach.
Our outputs to support this will be:
- A business and benefits case outlining the advantages and disadvantages of the approach
- A user research report detailing how we are have engaged with users and how they have influenced our approach
- A service model to demonstrate to others how we have implemented the approach
- Our plan to embed the approach as business as usual
This work and the demonstration of the outputs will be compiled ready by the dedicated project manager using the data and evidence throughout the project. This will obviously be in collaboration with the staff across the organisations involved.
We will engage with two categories of users, firstly our service users: anyone with eligible needs who is prescribed community equipment, minor adaptations, Telehealth, Telecare or Technology-Enabled Care; secondly, our clinicians and social care staff who will also use and help service users to use, the equipment and technology.
We will engage with service users as follows:
- Invite groups of service users with specific needs to take part in technology trials. This will involve asking them to take part in regular feedback sessions about their experience to improve the products and delivery. These individuals may also be invited to join a user reference group to introduce new equipment and technology
- Creating a focus group of individuals who have been through one or more service to discuss key issues at a broader level and inform joined-up service design
To engage with professionals who will be using GETS, we will
- Carry out a series of targeted staff workshops to understand, need, opportunities, limitations and concerns at each level of implementation
- Create a project team to implement the project, on which will sit representatives from key teams
Digital leadership training
Anything we see helpful in progressing our project as our work and collaboration develops.
We have made use of internal funding to trial specific technology as part of the discovery pilot. We want to take forward this learning as part of the Alpha stage. However, we have not received or applied for any additional funding from other sources for this project.