Integrated Assistive Technology Commissioning...

Integrated Assistive Technology

Commissioning Strategy

2016 - 2021

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Table of Contents

Foreword

1. Our vision for Assistive Technology in Powys 5 2. What people have told us 5 3. Why this Strategy is important 6 4. Local challenges and opportunities 8 5. Commissioning Intentions 10 6. How will we know if we have succeeded? 17 7. Governance and monitoring of our commissioning strategy and commissioning intentions 19

Appendix A Needs and Demand

Appendix B Compendium of Good Practice

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Distribution History

Version Date Group

v1 13th March 2015 Integrated Care Pathways for Older People

Programme Board

v2 13th May 2015 PCC Adult Social Care Senior Management

Team

v6 21st October 2015 PCC Adult Social Care Senior Management

Team

v8 9th November 2015 Powys Teaching Health Board

v8 3rd December 2015 PCC Housing Management

v10 14th December 2015 PCC Adult Social Care and Housing Senior

Managers

PTHB Senior Managers

PAVO

v10 6th January 2016 PCC People Directorate Management Team

v14 14th January 2016 PCC and PtHB Senior Managers including ICT

v15 9th March 2016 ICT Leads

v16 April 2016 PCC Strategic Director – People.

PTHB Director – Primary and Community Care

Integrated Care Pathways for Older People Board

v17 June 2016 Joint Partnership Board

v18 September 2016 PTHB Mental Health

Final 5th December 2016 Signed off by Joint Partnership Board

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Foreword

We are pleased to present this first integrated strategy for Assistive Technology within Powys. We have worked together with service users, providers and health and social care professionals to build our future commissioning intentions based on what people have said is important to them. Assistive technology has a key role to play in the modernisation of health and social care. With ever increasing technological advances, it offers a range of possibilities for greater choice not only of how people can access the support they need, but also where and when they access support. In doing so, assistive technology enables people to take greater control, and to live independently for longer by preventing hospital admissions and premature moves to residential care.

Personalisation through assistive technology is based on offering choice and control to our customers, and working with them to co-develop individualised support plans. Assistive technology through the development of telehealth, telemedicine, and telecare services offers numerous possibilities depending on people’s needs and desires. Assistive Technology is used to describe the wide range of technologies that enable people to remain independent and exercise choice and control over how they access support, and how support is delivered. Assistive Technology includes high technological applications such as remote monitoring equipment, video links and emerging medical technologies that support diagnosis and management, clinical networks and health professional education, and lower technological equipment such as community alarms, low-tech assistive products such as plug-in motion sensing night lights & remote control sockets. There are also a wide range of free applications available for use on smart phones and tablets that people can use to improve their health and wellbeing such as physical activity diaries, weight loss coaching; sleep trackers, and health measurements.

Use of assistive technologies within Powys is in its relevant infancy, and we are committed to working together to seize the opportunities assistive technologies can offer to improve the quality of people’s lives. To do this we must both focus on raising awareness of the benefits that assistive technology can bring to people’s lives, providing clear and helpful information and advice, and work together with people to co-develop support plans that fully exploit the benefits that technology can bring in order to free up clinicians and carers to provide additional person centered care.

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1 Our vision for Assistive Technology in Powys

Our vision for Assistive Technology in Powys is that we work together with our public, patients, people who use our services and their families to take hold of and develop the range of opportunities advances in technology can provide to make sure that people in Powys:

Are supported to maintain their health and wellbeing;

Are given relevant information, so that they have an increased choice and control over what matters to them;

Have greater access to health and social care which is close to home, and can meet their needs;

Experience a good quality of life; and can live independently in their own homes for as long as possible;

Are supported to move back to their own home and communities following hospital discharges as fast as safety allows;

Have the choice and opportunity to take part in social activities and be included in the community, to maintain their well-being.

Are able to access a range of on-line support services such as CBT online therapies

By bringing together health and social care through shared processes, information systems and co-location, we will help maximise opportunities for individuals to be supported at home1. In doing so, we are determined that where ever possible, our older people, people with disabilities, people with mental health problems and other vulnerable people are able to live independently with in their own homes. Technology will play an increasing role in delivering this vision.

2. What people have told us

In developing our Integrated Older Peoples Commissioning Strategy, our Integrated Carers Commissioning Strategy, and our Integrated Learning Disability Commissioning Strategy, we have engaged with a range of people who currently use health and social care services, or have an interest in helping to improve the quality of lives of people across the county. Through this engagement, people have given us their views through surveys and focus groups, and this has helped us to understand people’s opinions on current services and future plans.

1 PCC/PtHB Statement of Intent, 2015

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We have listened to the people who use our services and have adapted the national outcomes framework which is being used across Wales. This framework has carried out extensive research on the expectations of older people across Wales. In developing our commissioning intentions we have also drawn on best practice and consultation undertaken across the UK. Such considerations for example included a survey undertaken by Carers UK and Tunstall2. An analysis summary of need is provided within Appendix A. Appendix B includes a compendium of good practice used within the development of over commissioning intentions from around the UK. Powys is also one of six regions in Europe taking part in the ‘Care Well’ Project, which looks at how technology can support integrated care for frail older people. In Powys 100 patients are taking part in the project which is exploring how mobile devices can enable community workers to share health and social care information. People’s views and learning gained from this exciting initiative will continue to shape our future commissioning intentions as additional opportunities to improve the quality of people’s lives through targeted use of assistive technologies are identified. We are committed to talking with staff, patients, carers and the public about any proposed changes to local services. We also remain committed to supporting people to become more actively involved in influencing decision-making relating to local service provision. In developing this Strategy, we have engaged with a number of interested people and organisations, and they have given us their views through surveys and focus groups. All of their views have helped us to understand people’s opinions on current services and future plans. As this commissioning strategy considers proposals for a wide range of commissioning intentions across organisations, additional engagement and/or consultation will be undertaken as appropriate, and will specifically be undertaken at any time significant changes to healthcare services are being considered.

3 Why this Strategy is Important

This strategy outlines our commissioning intentions through which we will use assistive technology to support people with Learning Disabilities, Older Peoples, and Carers. In developing the commissioning intentions we have both listened to what people say is important for them, and help developed plans to help deliver the County’s Learning Disability, Carers, and Older Peoples Strategies. The development of assistive technology services will be critical in supporting each of the above strategies. This Strategy will provide a clear direction regarding how the benefits of assistive technology can be seized and exploited within the future planning and delivery of health and social care for residents of Powys. Initial investment will be required to enable assistive technology services to be established. In developing our commissioning intentions, we are keen to empower people to maintain and improve their own health and wellbeing. This includes developing and

2 Carers UK – Potential for Change (2013)

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supporting access to local assistive technology markets by people of all ages, and support needs from early intervention and targeted prevention support, to specialist care services in line with the Health and Adult Social Care Promotion of Independence / Continuum of Need as detailed below.

Figure 1 Health and Adult Social Care promotion of independence / continuum of need

Our future service models will promote independence through active management of risk and has three core elements: 1. Universal approach; Primary self- care and prevention.

Services will be focused on developing and maintaining individuals’ independence through supporting the development of a strong community network and assistive technology services at home. Promoting digital inclusion and social media applications that can reduce isolation and loneliness. Developing services which can support the population to improve their awareness of health advice and services.

2. Targeted approach; Community care and enhanced complex care

Assistive Technology will be a core service delivered as part of all integrated care plans across health and social care. It will enable more people to be cared for and treated at home and will reduce unnecessary admissions to secondary care or private sector and facilitate timely discharge from services outside of Powys.

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Assistive technology services will support self-management programmes, enabling support regardless of where the individual lives for adults and young people.

3. Specialist approach; Acute and specialist care

Services will continue to be available for people with complex needs, who need

specialised care; this will mainly be delivered in an acute hospital,

residential/nursing home or hospice setting. However where appropriate and

backed up with support services, Assistive technology will be provided locally

within the home or community. It will be important to develop roles such as

telehealth/telecare support officers to support individuals’ access to assistive

technology.

4. Local Challenges and Opportunities

This AT Strategy will support us in addressing the key challenges and opportunities set out below and will enable people to take greater control over the support they receive, and how that support is accessed. Rural Living Rurality and accessibility to services is a key challenge in the planning and delivery of all services. Greater use of assistive technology will enable more people to be able to access health and social care support closer to home, and with many technologies being accessible directly from peoples’ own homes. Assistive technology will be considered in the way we commission and deliver all future services to ensure we meet individual needs as close to people’s own homes as possible. Local plans will need to promote digital and social inclusion. Public Health

Increases in our ageing population will require future services to support an increased number of older people who may have multiple long term conditions to continue to live with dignity and independence at home and in the community. The increased use of assistive technologies will promote greater choice and control over how and when they wish to access the support they need.

Quality

It can be difficult to staff services in multiple locations with low levels of activity, resulting in relatively low levels of productivity. Assistive technology can be provided across a wide range of locations and directly into peoples’ own homes. The provision of technology can also help to improve service quality and promote greater equality

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of access to support. It is also anticipated that greater availability of assistive technologies across the county will reduce waiting times for many types of support, enabling more people to access support within their local communities or home without the need to wait for an appointment within more formal health settings.

Financial

We are working in an environment where there is a reduction in national financial expenditure which requires a more innovative approach to how we provide future services to meet older people’s needs. Investment in assistive technology will enable more people to be supported directly in their own homes at all times of the day. This will both reduce the cost of travel and travel time for people accessing support, and make many public services more cost effective. Workforce Historically we have struggled with recruiting GPs, Consultants, Social Workers, Domiciliary Care Workers and other clinical staff, in part due to the national recruitment issues and as a result of our rurality. There is an expectation to provide services 7 days a week and to extend some services into the evening which will have infrastructure implications. Use of assistive technology to replace and enhance services will enable improved targeting of health and social care workforces to support people with the most complex needs, whilst at the same time as supporting people with lower care needs to self-care in the knowledge that appropriate technological support is available to meet their needs. Our front line staff who assess needs will require training and will need to have confidence that the provision of AT can manage risks to individuals. Likewise, support will be required to individuals to improve their confidence in the use of assistive technology.

Estate

Our estate has served us well, but is ageing and some properties are no longer fit for purpose to deliver future health and social care. AT will provide opportunities to reduce dependency on buildings, allowing us to support people from across a range of local community facilities and within peoples’ own homes. Investment in our older persons designated housing stock needs to future proof homes. The introduction of assistive technology within the outpatient setting will need some investment to ensure equipment is able to provide pictures and diagnostics to support video assessments and consultations.

Our health and social care buildings should be digitally enabled for the public to access Wi-Fi and to enable them to use assistive technology whilst they receive services. The design, accessibility and security of our ICT systems will need to be enhanced.

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5. Commissioning Intentions

Our proposed commissioning intentions over the next 5 years will help us to provide seamless and integrated health and social care support to people in need. We will therefore:

Raise the Awareness of Assistive Technology and promote Digital Inclusion

Enhance county-wide opportunities for Telehealth / Telemedicine

Focus on the development and implementation of Prevention and Early Intervention measures, and hospital discharge services

Update existing Supported Housing Schemes Alarms

Identify opportunities to support existing service user to access Assistive Technology through care plan reviews

Identify opportunities to support people with complex needs through targeted and specialist assistive technologies

Priority Lead By when


Commission good assistive technology information and advice for older people, their families and carers, promoting awareness of assistive technology options to support more people to continue to live at home and access health and social care services within their communities.

Director of Public Health

Strategic

Dec 2016

Evaluate the Care and Wellbeing pilot project seeking to develop assistive technology apps working with GP’s using Skype and other technologies to access local services, and access to trusted health care information.

Locality General Managers PtHB

Dec 2016

Improve access to communication technology. In particular:

Rollout LYNC to staff across the Health Board to enable improved care planning and patient access to services

Explore and implement where possible the feasibility of LYNC between health and social care providers (Primary, Secondary, Out of Hours and Health to Patient)

Improve WIFI infrastructure for staff and explore WIFI access for patients

Programme and Governance Senior Manager

2016/17

Train frontline Health and Social Care staff; Housing staff; and voluntary sector partners on the benefits of assistive technology.

Director of Workforce and Organisational development

Sept 2017

Retain 3 units in designated older person’s accommodation to host demonstration/training for Assistive Technology.

Head of Strategic Housing (PCC)

Nov 2016

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Telehealth and Telemedicine

Increase the use of video conferencing for patients to access specialist health services from local settings reducing the need to travel. Ensure the ICT infrastructure is in place to be able to access patient records.


Strategic Commissioning Manager: Older People (PCC)

Mar 2019

Work with GPs to develop an integrated approach to telemedicine and the use of diagnostic video conferencing services. This includes use of such developments in locality based facilities such as Extra Care facilities. Ensure the ICT infrastructure is in place to be able to access patient records.

North Locality General Manager (PtHB); and South Locality General Manager

Mar 2018

Continue to explore the use of self-management devices to monitor patients with long term conditions, especially COPD and Heart Disease, including the evaluation of a project on sleep apnoea

To deliver and evaluate the delivery of self-management groups via skype

To evaluate the impact and potential further rollout of the Mastermind project

To evaluate the impact and potential further rollout of the Carewell project

Implement the HETT funded patient self-management and education programmes

To introduce smart technology as part of the core health services which can support mutually agreed-upon self-management plan between a patient and healthcare provider. Eg Florence (Flo), NHS Simple

Lead Therapist PtHB and Programme and Governance Senior Manager

Mar 2017

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Evaluate the impact of the Physiological Therapies, and Pain & Fatigue pilot projects seeking to develop opportunities for Skype and other On-line video technologies for self-management and group therapies.

Clinical Lead for Mental health PtHB

Mar 2017

Explore opportunities to enhance Virtual Wards through investment in additional assistive technologies and ICT infrastructure.


Team Managers (PCC)

Mar 2017

Support individuals who suffer with dementia to remain at home using AT to include:

Care monitors

Alarms

Automated pill dispensers for individuals who struggle with the management of their medication

Dementia lead PtHB

Integrated Care Team Leaders

Dec 2016

Prevention and Early Intervention

Review the use of DFG’s and works of adaptation in Council owned properties to target investment in additional assistive technology that will support people to continue to live in their own homes without needing to move in to residential care.

Strategic Commissioning Manager: Assistive Technology/ Private Sector Housing Team Leader

June 2016

Risk profile individuals at all points of contact to identify opportunities to provide prevention services including Assistive Technology, and offer Assistive Technology Standard Prevention package consisting of Lifeline Alarm, Smoke Detector and Fall Detector Pendant to people assessed at risk of losing their independence over the next 12 months

Integrated Care Team Leaders/ Lead Clinicians

Sept 2017

Embed Assistive Technology consideration in Carer Assessments and emerging client information database (WCCIS)


Mar 2017

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Install targeted Assistive Technology as standard as part of all future reablement care packages to enable more people to regain and maintain their independence following their period of reablement.

Senior Manager: Older people (PCC)

Mar 2017

Develop a web-based self-assessment form to enable people to quickly identify equipment that is available locally to meet their needs.

Senior Manager: Older people (PCC)

Sept 2017

Facilitate the development of a self-help market to improve access for people to purchase low cost, simple pieces of assistive technology

Service & Commissioning Manager CES (PCC)

Mar 2018

Complete survey of community alarm users in public sector older persons accommodation and remove equipment where not required and install standard package in properties where tenants wish to continue to receive the service

Housing Management & Options Team Leader / RSL Partner Agencies

May 2016

Evaluate the case for a Community Alarm / Telemedicine response service


Service & Commissioning Manager CES (PCC)

Sept 2017

Re-assess existing service users to identify opportunities to use Assistive Technology to improve people’s independence. The focus will be on community based packages of care and will include the use of activity monitoring systems:

o Older People

o People with Learning Disabilities

Integrated Care Team Leaders.

Reviewing Officers.

Mar 2018

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o People with physical disabilities

o People with dementia

Carers

o Incorporate assistive technology as part of the transition management process as young people move on to enter adult services


Mar 2017

Young People: Engage with the schools based Special Educational Needs Co-ordinators (SENCO’s) in order to raise awareness of the positive impact assistive technology can play

Senior Partnership Manager (Childrens Services, PCC)

Mar 2017

Targeted & Specialist Support

Learning Disabilities: Work with Care Providers to increase the awareness and use of assistive technology

Senior Manager: Mental Health & Disabilities (PCC)

Mar 2017

Learning Disabilities: Review complex care packages to identify opportunities for assistive technology starting with a focus on complex care packages and shared accommodation


Sept 2017

Learning Disabilities: Review the opportunities to use assistive technology to support the repatriation of residents from out of county residential settings


Sept 2017

Mental Health / Dementia: Work with Primary Care to explore the use of medication compliance assistive technology to support people with mental ill-health and / or dementia

Lead for Medicine Management PtHB

Sept 2017

Mental Health / Dementia: Develop an easy to read toolkit aimed at users, carers and people with mental health problems and/or dementia services to provide information and guidance on assistive technology


Mar 2017

Mental Health: Explore the potential to develop video Asst Director Feb 2017

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consultations between GPs and otjher health professionals Mental Health, PTHB

Mental Health: further develop opportunities to deliver on line CBT therapies

Asst Director Mental Health, PTHB

Feb 2017

Carers: Explore the use of GPS technology to increase the independence of those with dementia and to support their carers

Strategic Commissioning Manager: Social Inclusion

Sept 2017

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6. How will we know if we have succeeded?

Our overall strategy and plan aims to achieve the outcomes in the table below. The measures listed in the table will show how we will know we have been successful, we will further develop these after consulting the public, to find out whether or not our commissioning intentions, once in place, improve the outcomes for people in Powys.

Priority Measure


Percentage of people who said that they or their carers were given

all the information they needed to understand what assistive

technology was available to meet their needs, and how to access

appropriate equipment.

Number of admissions to hospital reduced due to care being provided closer to home.

Percentage of people whose quality of life has improved from the

use of assistive technology.

Percentage of people who report that the introduction of assistive

technology means that they can access the support they require

within their local community or at home.

Telehealth and Telemedicine

The number of patients aged 65 and over admitted to hospital as an emergency per 10,000 population.

Availability of Pharmaceutical support for discharge.

The rate of older people helped to live at home through the use of assistive technology per 1000 population aged 65 and over

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Percentage of people who are supported to self-mange chronic conditions.

Percentage of people reporting that assistive technology means that they can do the things that matter to them

Mastermind – through EU audit tool

Prevention and Early Intervention

Percentage of people supported to live independently at home.

Following a period of reablement, 40% of people will not need any ongoing support.

20% will need a reduced level of support.

80% of people will achieve their outcomes.

Percentage of people who have a reduction in the size of care packages resulting from increased use of assistive technology

Percentage of young people supported by Special Educational Needs Coordinators that report that assistive technology has improve the quality of their educational experience and achievement.

Targeted & Specialist Support

Increased number of carers supported by assistive technology

The number of people with a diagnosis of dementia that are supported to continue to live at home

7. Governance and Monitoring of our Commissioning Strategy and Plan

The delivery of this commissioning strategy and plan will be monitored through the

Joint Integrated Care Pathways for Older People Board and Powys teaching Health

Board’s Service Reform Programme Board.

This is a live document, it will be reviewed on a regular basis and robustly managed

through our programme plans set out by the Integrated Care Pathway for Older

People Board.

The Commissioning Strategy and Plan will be available on our websites.

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Appendix A

Needs and Demand

Population

Powys is the largest county in Wales with a total population of 133,000 in an area of just over 2,000 square miles. Covering a quarter of the area of Wales, it is the most sparsely populated county in the country, with just 26 people per square kilometre. The challenges of planning and delivering an effective high-tech service across Powys’ many rural communities will be challenging and require innovative solutions that underpin equality of access. Key population changes are detailed below:

The number of people aged 65 and over (currently 34,638) is projected to increase by 11% over the next five years, and by 43% by 2036. The number of people aged 85 and over is expected to increase by 19% over the next 5 years and by 146% by 2036 (2011 census). As the number of older people in the population increases, the proportion of the population with long term conditions is likely to rise. An increase in levels of long term conditions will impact on demand for health services – both planned and emergency care.

The proportion of young working aged people (20–39) is substantially lower than that of Wales - this has implications for the care workforce and service delivery.

6.1% of the population report having bad or very bad health. Whilst this is lower than the Welsh average there is considerable variation across communities. The proportion of residents reporting bad or very bad health ranged from 3.1% in the St. Marys area of Powys to 13.3% in the Ystradgynlais area. A key aspect of long term condition disease management is self-care, giving patients / citizens ownership of their own health.

The proportion of residents whose day-to-day activities are limited a lot or a little by a long-term health problem was below the Welsh average. However, again the county average masks variances across communities and ranged from 15.8% in the Felinfach area to 33.8% in the Ynyscedwyn area. The areas with the highest percentages are found in the Ystradgynlais, Llandrindod East/Llandrindod West, Cwm-twrch, and Ynyscedwyn areas of Powys.

‘Access to Services’ measures the journey time to services such as GP’s, leisure centres, etc. Powys is considered the most deprived authority in Wales in regards to Access to Services.

Housing is also a central part of an effective care and support system and a key element of an individual’s well-being. There is evidence to suggest that specialist housing and housing related support can help people to live

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independently in the community for longer and can reduce the need for care / support and prevent poor health.

Demand for services

The demand for all types of health and social care provision is anticipated to increase over the foreseeable future. In line with population need, analysis indicates that there are four key inter-related factors which are crucial in understanding the current and future need and demand profile for older people in Powys:

an ageing and longer-lived population;

rurality;

access to service issues;

deprivation.

All of these factors represent a major challenge in designing and delivering services with the resources available. Current use of Assistive technologies in Powys The use of AT in Powys is in its infancy. The current range of AT offered by Powys is limited to basic alarms, pendants, and smoke detectors to around 2,000 people. Referrals for this equipment are predominately via self-referral. Currently, installations are carried out by Tunstall within the sheltered schemes and by Social Care funded wardens for the Careline customers in the community. Careline and dispersed alarms in Powys sheltered schemes are connected to the Careline monitoring centre provided by Carmarthenshire County Council. Careline respond to an incoming alert by making contact with the nominated responders for an individual or emergency services. In considering our strategy for the future these factors and the overall characteristics of our provision indicate that if we were to carry on with present access arrangements and the current approach to provision we could expect to see by 2021 an overall increase on our services by almost 40%. Clearly this would be neither practical nor affordable. It is in this context that our plans for the future have to be made.

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Appendix B

Compendium of Good Practice

1 Good Practice Case Study on Dudley Council demonstrating how the Dudley Telecare Service can reduce length of stay in hospital, or entirely prevent hospital admission.

IEWM case study -

Dudley MBC Telecare-Reablement.pdf

2 Report of an Automated Pill Dispenser Project undertaken in the West Midlands evidencing savings to Social Care and NHS Budgets. IEWM West

Midlands Pill Dispenser Summary Report.pdf

3 Sandwell MBC focused project on increasing the use of telecare for people with Learning Disabilities to demonstrate improved independence and to incorporate telecare as a key element within the care package. There was recognition that there would also be significant opportunities to realise cashable efficiencies through the introduction of telecare and the reduction of waking/sleep-in care.

Sandwell MBC - LD

Telecare project summary.pdf

4 An information tool kit to support people with Dementia, their Carers and Dementia services.

Dementia-Assistive

Technology toolkit.pdf

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