SmartCareMarlene Harkis Service Development Manager Scottish Centre for Telehealth and Telecare

• Process of redesign

• The technology/digital tools

• How are we doing it

• Timeline

Background

SmartCare in Scotland aims

• To improve the health, care and wellbeing of 10,000 people aged 50+ within Ayrshire and the Clyde Valley.

• It will do this through better co-ordination and an improved approach to falls prevention and management.

• It will fully utilise ICT services and applications that are vital in supporting integrated care.

Geographical Focus

• NHS 24 has a national responsibility in Scotland as advisor, facilitator and promoter of technology enabled health, care & wellbeing for 5.2m population

• SmartCare’s overarching pop – 1.1m (20% of Scotland’s population)

• Project involves :– seven local authorities and three

territorial Health Boards– Range of voluntary, charitable &

independent sector organisations– Service users and carers

Intense support

Rehabilitation and enablement

Staying independent

Community wellbeing

6

Hospital or care home

Incre

asin

g Fra

ilty

250

750

2000

3000

User Stratification

Active Engagement

• A range of stakeholder events have been organised throughout 2013/14, involving:

– Strategic Stakeholders (SG, JIT, NHS Scotland, COSLA, Carers Scotland)

– Implementation Stakeholders (Falls leads, Health Boards, Local Gov, 3rd Sector)

– User and Unpaid Carers

– Industry

Community Pathway

• Single point of entry

• Basic screening • Data entered

onto common database

• Enrolment onto Falls Prevention programme

• Integrated Falls Prevention Plan Actioned

• Update database

• Falls plan monitored

• Regular review

Assessment Care PlanEntryReview

Deliver

Exit

• Triage• Care co-

ordinator identified

• Update database

• Signposting for self-help

Exit

• Agree interventions

• Create Integrated Falls Prevention Plan/ Goals/ Outcomes

• Co-ordinate delivery

Improvement Areas Aim ICT Enabler

Single Point of Contact for Entry

Easy and simple access to falls advice and services

Living it up Platform (LiU)

Assessment Promote self assessmentSupport Professionals to good practice, accurate assessment of need and support quicker access to right services.

Electronic Assessment Tool

Intervention Care Planning

Person centred care planningInterventions to help achieve personal outcomes

Exercise Apps & Games

Care Co-ordination Support person to organise their care Coordinate activity to support independent living.

Diary/Calendar - New

Shared Information Person centred approach to support person to link information regarding their needs.

Person Held File (PHF) Community Connections

Self Management Sustainability; support people to manage Long Term Conditions and prevent further Falls

Telecare & Home Monitoring Services - Existing

Database Collect evidence which can be used for service planning.

Database - Existing

What is SmartCare?

SmartCare – ICT enablers

Independence and Enablement

Self assessment, fast access to falls pathway other servicesProfessional Assessment Basic screening information Triage tool Multifactorial assessment

Care plan -Intervention Use ICT enablers to improve

compliance/motivation Personal targets Apps for exercise, personal targets, diet,

gamification Inform multidisciplinary assessment and hospital

admission

• Co-ordination– persons needs will be varied according to LTC and level of

independence

• Pull together key events & supports - diary - Link with agencies - Home care

- GP Hospital appointments

• Adapting existing systems– home care, equipment

Diary/Calendar

Person Held File• Shared information -Remove duplication/repetition -Improve accuracy

• Ownership- person - Share with key supports

• Who I am-how I want things organised-anticipatory care

• Health and Social care- input from self, carers, care

providers,- Health and social care

• Signposting – local services, events

• Social networking- Peer groups, experience guides, blogs

• Keeping in touch– Video conferencing family, friends, carers

• Preventing isolation– Keeping active

Community Connections

How?

LiU Platform

LiU prototypes – SmartCare points

Social links Local

assets Self assessment & Calendar

diary

Person held

record

Co Production

• Engage with key stakeholders

• Use the lessons learned from LiU

• Reference group

• test - adjust – try again

• Third sector engagement

Procurement

• Framework – skilled industry partners

• Work in collaboration

• Direct user involvement

Points to consider

• The contribution you can make to the design of the tools

• How technology will change the delivery of care

• What will your customer expect in the future

• How we can support digital inclusion

Improved outcomes

• Shared information = Accurate assessement of need = effective intervention

• Calendar = Agreed care plan = minimal changes = early notification of changes = support carers

• Self assessment = early identification = self management

• Community connections = keep active= health & wellbeing

• Sustainable

SmartCareIMPLEMENTATION TIMELINE 2013 – 2016

Oct 13 Jan-15 Feb-15 Mar-15 Apr-15 Feb 2016

User & Carer Events

Suppliers Events

Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 July-14 Aug-14 Sept-14 Oct-14 Nov-14 Dec-14

Evaluation Before Sample

Contract Awarded

User & Carer Event

Co Design Event

Suppliers

Prototype

Testing

SmartCare on LiU Platform

Procurement

LiU Go Live

Procurement issue tender

invite

Launch Event

General Assembly

Evaluation 2nd Sample

ReviewReview

Project Completion

For more information, contact

Marlene.harkis@nhs24.scot.nhs.uk

www.sctt.scot.nhs.uk

www.livingitup.org.uk