Development of Telehealthcare in Scotland
The development and expansion of telehealth and telecare (or telehealthcare) has been actively championed by the Scottish Government, COSLA and NHSScotland across a wide range of policy portfolios for a number of years. The National Telehealth and Telecare Delivery Plan for Scotland to 2016 sets out the national work programme on Telehealth and Telecare over the next few years, and part of that involves the JIT actively supporting partnerships to move this agenda forward locally.
Due to continued advances in technology, telehealthcare can now be deployed effectively in all sectors and across the breadth of our care pathways: within the home; in primary and community care; in supported housing, hospitals and care homes; and within acute care and our emergency care services.
The JIT has long championed the use of telecare and telehealth in supporting people to remain in their own homes, or in a homely setting. The primary driving force behind this was the Telecare Development Programme (TDP) which ran from 2006 – 2011. The most recent evidence to emerge from the TDP comes from the York Health Economics Consortium report (published in April 2013) into Renfrewshire’s use of Telecare to support people with Dementia in their own homes, which demonstrated the significant benefits of utilising telecare in Scotland:
- Self-reported outcomes provided by Renfrewshire Partnership gave estimated net savings attributable to the 325 clients with dementia, over the five-year period, of over £2.8 million, equivalent to about £8,650 per client with dementia receiving a telecare system.
- The major savings were identified as eighty eight admissions to care homes avoided, saving 606 days each, at a daily saving of £48.06 (£29,124 per event), giving total savings of £2.55 million. A further £0.75 million was saved by 114 hospital admissions avoided.
Conclusions from this report were that the evaluation demonstrates telecare can be used to support a significant proportion of people living with dementia to remain safely in the community and that they, and their carers, are generally satisfied or highly satisfied with the service. The major resource saving is likely to be care home admissions avoided.
Overall, almost 44,000 people began a telecare service through TDP funding over the period 2006-2011. Around 2,500 hospital discharges were expedited as a result of TDP funding, whilst at the same time around 8,700 unplanned hospital admissions and over 3,800 care home admissions were also avoided.
By achieving the above outcomes, partnerships saved around:
- 546,000 care home bed days;
- 109,000 hospital bed days through facilitated discharges and unplanned admissions avoided;
- 48,000 nights of sleepover/wakened night care;
- 444,000 home check visits.
Taken as a whole, the gross value of TDP funded efficiencies over the period 2006-11 was approximately £78.6 million at 2011 prices. It should be noted however that, unless actual care home bed reductions, hospital ward closures and other service adjustments were subsequently made, these efficiency gains will not have resulted in cash releasing savings.
- The average number of hospital bed days saved per reduced delayed discharge was 11.
- The average number of hospital bed days saved per unplanned hospital admission avoided was 9.
- The average number of care home bed days saved per care home admission avoided was 143 (or roughly 20 weeks).
Despite the undoubted success to date, the recent Improvement & Support Review of partnerships’ first iteration of their Joint Strategic Commissioning Plans showed that, whilst partnerships were in general agreement about the important role that telecare can, and does play in keeping people safe in their own homes, plans reflected a general uncertainty about what to do next with most recognising that they could do more.
We are working very closely with the Scottish Centre for Telehealth and Telecare in supporting partnerships’ drive to increase their use of technology as part of effective service redesign locally.
Review of Progress
When we reviewed the Telehealth & Telecare Delivery Plan in the spring of 2014, we established that whilst significant progress had been made in terms of testing and exploring the use of telehealth-based solutions – including through greater use of video consultations, particularly in remote and rural communities – telehealth is not sufficiently embedded or embraced by clinicians and NHS services across primary and secondary care. There remains as well limited interoperability with the core eHealth systems. We also lack robust local Telehealth infrastructures or a national Telehealth infrastructure. In addition, although telecare is now well established across Scotland, considerable variation still exists across areas and there continues to be patchy adoption of telecare as a routine response to facilitate early discharge from hospital, prevent admission and support people with conditions such as dementia to maximise their independence and provide support to carers. Telehealth and Telecare are also not yet integrated in ways that would support better person-centred care.
Partly with this in mind, and supported by both the then Health Secretary and the Health & Social Care Management Board, the Scottish Government’s Technology Enabled Care (TEC) Programme was developed and launched in the autumn of 2014. The TEC Programme is a major initiative focused on expanding the uptake of already tried-and-tested technology to support national health and wellbeing outcomes with funding of £30 million over three years.
To read more, and to access some of the latest resources, see http://www.jitscotland.org.uk/action-areas/telehealth-and-telecare/technology-enabled-care-programme/