Implementing Telecare
Ensure strategic leadership and governance

A project needs both support from, and ownership by, senior management, as without this it is likely to lack commitment from other staff, and will not receive the resources it needs. Equally senior management need to create suitable governance arrangements to ensure the project is targeted to wider strategic goals, and effectively project managed.

Strategic leadership

It is easy to initiate a project and generate early enthusiasm amongst those who are committed to telecare, or who believe they will benefit from introducing it. Sustaining a significant change depends on continuing budgets / resources, responding to other departments / services and having a robust defence against competing priorities. Allowing a project to be driven by one or two enthusiastic individuals who may move on can also present a significant risk to its success.

Senior management can support the successful delivery of a project by:

  • Publicly advocating telecare and showing how it supports wider strategic goals;
  • Committing adequate resources to it;
  • Keeping up to date on progress, and providing support through difficulties.

Even if senior managers have given their initial approval, those responsible for putting telecare into practice need to ensure that ongoing approval and support is maintained. Senior managers are key stakeholders, so in the earliest stages of the project those managing it need to put time and effort into understanding their interests, and how best to secure and maintain their support (e.g. by using Tool 2 – Stakeholder Analysis exercise).

Governance

Ensuring suitable governance arrangements which regulate the relationships between those involved in the project is crucial in maintaining senior support. If senior managers are committing significant resources, they will want reassurance that the project is delivering best value for their investment. This can be done by setting up a project governance structure, which links the project to the wider organisation.

This helps the project by linking it to relevant developments elsewhere in the partnership, and helps senior management to be informed about progress (e.g. regular six monthly progress reports to committees, boards, etc). It also allows the project to adapt and be responsive to certain changes in the wider strategic environment within the partnership.

Terms used to describe arrangements will vary locally, but at the highest level there will be some form of steering group / project board, a designated project manager / lead, and an identifiable group of people who are members of the project team.

Steering group

This links the project to the organisation, and consists of senior managers from the relevant departments or units affected. They will not engage in detailed work, but will expect to ensure that the project outcomes support the wider strategy, receive reports on progress towards those outcomes, and to act as necessary if there is significant variation. This role will usually be carried out by an existing body, such as a partnership board. It is useful to have key stakeholders represented on this.

Designated project manager

The project manager is responsible for ensuring that the project achieves the outcomes set out in the project terms of reference document. Depending on the scale of the task, they may work full-time or part-time on it. They may be seconded from their normal duties for a limited period. They will be responsible for reporting to, and receiving instructions and advice from, the steering group. As well as selecting the person, senior managers also need to set out clearly their responsibilities, a job description (see Tool 8 for a sample Project Manager Job Description) and reporting requirements.

The project team

The project manager will need the support of other people. They may be in other services or organisations, so it is likely that the project manager will have no formal authority over them. If project work also competes with their regular work (which will usually take precedence), progress may be slow. Senior management can counter this by creating a specific structure – a project team, with terms of reference – which signals that the project is a separate task. Staff can be visibly appointed to the team, for an agreed and designated amount and duration of time. From a reporting and governance perspective, team members will meet regularly to decide what they need to do next, who will do it, and by when. They can then report progress as agreed, which in turn forms the reports to the steering group.

Tool 5 – Agreeing project governance arrangements exercise

Activity guidance

Develop recommendations for an appropriate governance structure for the project, ensuring that key strategic stakeholders (e.g. elected members, budget holders, etc) are included in the reporting framework. Example:

Draft the membership and terms of reference for the steering group, ensuring that appropriate representation from all key stakeholders is secured. See Tool 6 for a sample template.

Identify meeting dates for the next 6 months to 1 year to secure the attendance of key stakeholders at project steering group meetings.

Tool 6 – Sample Template for Project Steering Group Remit

The role of the Telecare Project Steering Group is to lead the implementation of telecare within the xxx partnership.

Remit

The Steering Group will direct the development of telecare, with a particular focus on:

  • Integration of telecare into mainstream services including primary care, secondary care, social care and the voluntary sector
  • Flexibility and responsiveness to individuals and carers
  • The development of practices and processes that are fit for purpose (including assessment, care planning and service planning/evaluation)
  • Planned, anticipatory care / proactive interventions

Tasks

  • Ensure connection with relevant partnership strategic agendas
  • Ensure connection with relevant Managed Clinical Networks, Older People’s Services, Children’s Services, Mental Health & Learning Disability Services
  • Agree an annual implementation plan for the development of telecare within the partnership.
  • Monitor and support the effective management of project risks.
  • Identify and optimise joint care approaches and common functional outcome measures
  • Identify and optimise use of interagency care pathways
  • Participate in monitoring and evaluation of impact of telecare on service delivery
  • Ensure clear, valid process and outcome performance measures and that all agencies participate in audit
  • Ensure alignment with the National Telecare Strategy

Annual outcomes

Review progress against agreed priorities in the Telecare Implementation Plan and revise in accordance with Local Authority and NHS Board priorities.

  • Senior Partnership Representative (Chair) – health or local authority
  • Senior Partnership representatives’ e.g. Social Work Head of Community Care, Community Health Partnership General Manager, etc.
  • Key operational managers in health, social work, housing, related services (e.g. Call Monitoring Centre, etc)
  • Voluntary Sector / Lay representative

(The Steering Group does not need to include every possible stakeholder – just those with the power and influence to direct the implementation of telecare).

Key functions and responsibilities of individual members

  • Members should effectively represent a body of opinion, not just their own.
  • Members must take responsibility for the timely promotion of two-way communication between the Telecare Steering Group and all relevant partnership colleagues/organisations.
  • Members should commit to regular attendance at meetings, as continuity and balance of input into the decision making process is of the utmost importance.
  • Members should strive to ensure that an appropriate deputy attends meetings in their place to ensure that a balanced complement of representation is always present and that each meeting is fully quorate.
  • If a member of the Steering Group will be unable to attend a meeting, he/she should inform the Steering Group Administrator.

Meetings

The Telecare Steering Group will plan to meet every [insert frequency e.g. two months (with a minimum of four meetings per year)].

Items for the agenda

Submissions should be sent to the Steering Group administrator no later than 2 weeks in advance of meetings. Items will be considered from any group member or from any individual, group or organisation represented or affected by a strategic decision.

Deputies

Members have responsibility to send a deputy in the event of their absence.

Quorum

The meeting quorum will be 5, which should include the chair or nominated deputy. Deputies will contribute to the quorum.

Chairperson’s powers and voting rights

The Steering Group will work in a consensual manner. In the event of the Chairperson identifying the need for a vote, voting will be by simple majority. All members of the Group have equal status.

Practice examples and further information

Links to examples of related documents produced by telecare partnerships from across Scotland and the UK and further information can be found in the Telecare Resource Bank. These include:-

  • Aberdeenshire Telecare Group Terms of Reference
  • Edinburgh Steering Group Design and Reporting Structures

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