APPENDIX ONE - Hampshire County Council Social Services Department - An Evaluation of Telecare in Social Care: Summary Interim Report April 2005

By: Carole Bennett, Strategic Planning Manager, Performance Management Unit

1. Purpose of this Report

This document is a summary of the key findings and conclusions from the interim report on Telecare. The purpose of the evaluation is to enable a better understanding of how telecare can support the County Council's Corporate Strategy and strategic aims for social services for older people to promote independence at home, increase service capacity and modernise residential and nursing care. The interim report focuses on Phase 1, the development stage, of the department's Telecare Project.

1.2 The Principle Aims of the Evaluation:

(i) To provide information which will enable the department to determine the extent to which telecare can support meeting its strategic objectives for services for older people

(ii) To provide a framework for data collection for incorporation into the planning stage of proposed new telecare services.

Evaluation Objectives

Phase 1 - Development

· Map the range of telecare products and their current or potential applications within social care. Target date: January 2005

· Develop a framework to enable the evaluation of telecare products purchased by the department. Target date: January 2005

· Design a minimum data set across care settings to inform planning and strategic development. Target date: first draft Dec 2003

Phase 2 - Implementation

· To analyse both qualitative and quantitative information on the costs and benefits of telecare Target date: June 2005

1.3 Methodology

A steering group was set up to oversee the pilots, commission the evaluation and provide local knowledge An internet search was conducted to establish the context of Telecare nationally and internationally and to determine a definition for Telecare. Visits to learn from other local authorities experiences were also undertaken, as was a literature review of projects and evaluations that involved Social Services or had a social care context.

A review of the project record and reports has also been undertaken and interviews with managers and staff involved in the Hampshire pilots.

A framework for data collection has been developed in the form of a minimum data set with information collected via care management questionnaires and service user interviews carried out by the Project Co-ordinator. Responses have been analysed and some early findings are contained in the main document.

Table 1. Provider Comparisons For the purposes of a comparator analysis, four providers who are known to provide telecare in the UK have been identified. This list is not exhaustive.

	Huntleigh Healthcare	Tunstall	Vivatec	Attendo	Tynetec
Product	Insight Active Support Environments	Lifeline 4000+ & sensors	WristCare	Horizon Carephone & sensors	ALTec Smart Sensors
Claims	Person Centred. The system identifies a risk situation within the clients dwelling. It communicates with the client to make them aware of the situation. If mediation fails or the problem persists, outside help is contacted	Innovative range of non-intrusive smart sensors work with a Lifeline unit to offer a comprehensive way of managing the risks to a person's health and home environment.	Only alarm system available which using only one intelligent unit has manual help button (client wears wristband even bed), checks client is conscious (using automatic sensors in wrist unit), is wearing the device, is at home (can be programmed for wandering). Sends activity data for monitoring persons well-being.	Offers a range of sensors to provide individually tailored solutions to facilitate the provision of care and support within independent living settings	Smart technology systems continuously monitor and record the sensors so activity can be reviewed.
Location of Installations in UK	1 private customer in Southampton. Other installations existed but locations unknown.	Nationwide	Nationwide e.g. Birmingham, Tameside, Eastbourne.	Nationwide e.g. Sandwell MBC, Columba Project, Surrey, Headbourne Worthy House retirement homes	No information
Equipment	Computer, modem, passive infra red movement detectors (PIR's), smoke detector, thermostat, big button telephone, OK/help buttons, external door open/closed sensor, window open/closed sensor, speakers, bed occupancy sensor, chair occupancy sensor.	Lifeline 4000+ , fall detector, pendant alarm, movement detector, bogus caller button, smoke detector, natural gas detector, gas shut off valves, temperature extremes sensor, pressure mat, carbon monoxide detector, flood detector, pull cords, chair/bed occupancy sensor, sounder beacon (hard of hearing), wandering client.	Wristband worn on wrist, base unit plugged into standard 13 amp socket and telephone line.	Horizon Carephone, flood detectors, PIR, fall detector, gas detector, smoke detector, extreme temperature detector, bogus caller, pill dispenser, care sensor (wall above bed - reads image of person in bed and alerts when out/not returned), visual call beacon, pendants (neck or wrist)	Pendant and wrist alarms, fall detector, smoke detector, heat detector, enuresis detector, flood detector, PIR, bed occupancy, pill dispenser, natural gas detector, carbon monoxide detector, door/window contact, pull cords.
Required	BT telephone line	Telephone line	Telephone Line (any provider)	Telephone line required	Telephone line required
Wireless	Hardwired	Wireless	Wireless	Wireless	Mostly wireless
Other agencies needed	Monitoring centre (needed for third party response.) Care professional needed to analyse activity patterns	Monitoring centre Care professional needed to analyse activity patterns	Monitoring centre Care professional needed to analyse activity patterns	Monitoring centre.	Monitoring centre
Interacts with clients first	Yes	No	No	No	No
Maintenance	£500 per year. This includes on-site maintenance and support during normal working hours. Maintenance of equipment damaged or inoperable through normal wear and tear. Annual service of system components with all batteries replaced. 24/7 information service for client's nominated local support centre of care agent. Up to 2 one site reassessments may be undertaken if required in the year	No information	Batteries need changing. Faults dealt with by returning product to Vivatec	60 service engineers nationwide. Can service other manufacturers. Different levels of cover available.	Customer support engineers
Costs	£4,950 for four roomed dwelling with single occupancy. Package as above (5 PIRs, 4 window sensors, 2 speakers)	Vary according to size of package	£800 1-19 units £650 20 - 49 units £600 50 -99 units Vista software £3,000 Computer for activity data	£1,000 for above plus £65 per PIR £65 per doormat	Depends on volume ordered. £79.50 PIR £40.50 door contact
Purchase/ Rental	Daily rental £9.95/6 rooms £11.95 /10 rooms.	Both options available	No information	No information	No information
Lifespan/ Guarantee	None supplied	Full warranty for 12 months. 24-hour emergency response.	Two year warranty	No information	All products has 2 year warranty. Spare parts can be supplied for at least 10 years.

Table 2. Telecare and its application within Social Care.

This exercise was undertaken to assist the department understand the circumstances under which telecare might help meet the needs of vulnerable people. The needs met are those set out in the County Council's social services eligibility criteria. These are based on the national eligibility criteria for social care.

Item	Function	Risks managed	Needs Met (from SSD eligibility criteria)	Providers
1. Information Processors
Computer (master unit)	(i) Processes data from sensors (iii) Programmed to detect unusual patterns of activity from sensors (ii) Interacts with client (iii) Activates modem	Helps self manage the home environment Independence Privacy	Choice and control over immediate environment	Huntleigh
Modem	Automatic transfer of data via domestic telephone line to summon assistance	Supports functions of computer, personal equipment and home sensors		Huntleigh
Master Unit: Invicta Lifeline Base Unit Horizon Carephone	(i) Programmed to detect clients unusual patterns of activity from sensors (ii) Automatic transfer of data via domestic telephone line to summon assistance	Supports functions of personal equipment and home sensors		Tunstall Vivatec Attendo
Speakers Sounder Beacon Visual Call Beacon	To communicate to client	Supports functions of personal equipment and home sensors Beacons for sensory impaired		Huntleigh Tunstall Attendo
Big Button Telephone	Replaces normal phone for ease of use by client For Monitoring Centre to contact client	Supports functions of personal equipment and home sensors. Manages risks from frailty and visual impairment		Huntleigh
OK/Help/ Bogus caller buttons	On phone to facilitate client response/call for help	Supports action by master unit		Huntleigh Tunstall
Pull cords	To enable client to report need for assistance	Supports action by master unit		Tunstall Tynetec
2. Personal Equipment
Pendant (requires master unit) * Attendo & Tynetec can be on wrist or neck	Activated by wearer to summon assistance	Frailty Becoming too ill/unable to move to summon help	Health problems have or will develop	Tunstall Attendo Tynetec
Fall Detector	Worn on waist and detects when wearer has fallen over	Frailty Falling and being unable to seek help	Health problems have or will develop	Tunstall Attendo Tynetec
Wristband (requires base unit)	(i) 24 hour monitoring of vital signs of wearer and detects abnormalities (ii) Activated by wearer to summon assistance (iii) Provides personal health data for analysis purposes	Becoming ill/unconscious/ unable to move and unable to seek help	Health problems have or will develop	Vivatec
Pill dispenser	Easy opener/organiser for taking medication on time	Forgetfulness Frailty	Personal Care	Attendo Tynetec
Enuresis detector	Detects incontinence in bed	Personal hygiene	Personal Care	Tynetec
2. Sensors in the Home
Passive Infra Red Detectors (PIRs)	Detects movement or lack of it	Becoming unconscious/unable to seek help Harm from intruders	Health problems have or will develop	Huntleigh Attendo Tynetec
Smoke Detector	Detects smoke Audible alarm	Forgetfulness Loss of sense of smell Faulty appliances	Choice and control over immediate environment Safety	Huntleigh Tunstall Attendo Tynetec
Gas Detector	Detects natural gas Audible alarm	Forgetfulness Faulty appliances	Choice and control over immediate environment Safety	Huntleigh Tunstall Attendo Tynetec
Gas Shut off Valves	Shuts of main gas valve when prompted by master unit	Forgetfulness Faulty appliances	Choice and control over immediate environment Safety	Tunstall
Carbon Monoxide Detector	Detects carbon monoxide	Faulty appliances Falling unconscious	Choice and control over immediate environment Safety	Tunstall Tynetec
Flood Detector	Detects overflowing water from sink/bath Activation reported by `master' unit	Forgetfulness Slipping/falling Damage to property	Choice and control over immediate environment Safety	Tunstall Attendo
Thermostat	Regulates heat in the home?	Personal comfort	Choice and control over immediate environment	Huntleigh
Temperature Extremes Sensor	Detects heat levels above or below those specified	Hypothermia Fire Damage to property	Choice and control over immediate environment Safety	Tunstall Attendo Tynetec
Door Sensors	Detects when door opened or closed. Unusual patterns detected by `master' unit	Wandering Harm from Intruders	Choice and control over immediate environment Safety	Huntleigh Tunstall Tynetec
Window Sensors	Detects when window opened or closed. Unusual patterns detected by `master' unit	Forgetfulness Harm from Intruders	Choice and control over immediate environment Safety	Huntleigh Tynetec
Bed occupancy sensors * Attendo = wall mounted PIR	Detects when client is in bed or leaves. Unusual patterns detected by `master' unit. Can also activate a bed side light	Night Wandering Falling (in dark) Becoming unconscious/unable to seek help	Choice and control over immediate environment Safety	Huntleigh Tunstall Attendo Tynetec
Chair occupancy sensors	Detects when client is in bed or leaves. Unusual patterns detected by `master' unit	Wandering Becoming unconscious/unable to seek help	Choice and control over immediate environment Safety	Huntleigh Tunstall
Pressure Mat	??			Tunstall

2. Analysis of Findings

The Hampshire pilots have experienced a number of delays and `live' equipment has not been available for a sufficient period of time to enable improvements for users to be measured. Outcomes such as reductions in falls, hospital admissions etc. will require long-term studies of quite large groups of service users. It maybe that national study will help inform the project in this respect.

All users have received a care management assessment and arrangements are in place to visit them regularly to seek their views on a range of matters. This information can be more meaningfully analysed once there are sufficient numbers of users who have experienced working telecare systems over several months and can have their level of risk reviewed.

The focus of the project to date has been on learning about the providers and telecare equipment available and it how could support older people to remain independent. Work has also included researching and networking with other councils in the UK and with European partners to learn of developments elsewhere, as well as developing partnerships with district councils, housing associations and the health service.

3. Conclusions

The agreed purpose of this evaluation of telecare is to enable a better understanding of how telecare can support the department's strategic aims for services to older people - to promote independence at home, increase service capacity and modernise residential and nursing care; as well as supporting the achievement of performance targets.

These broad objectives were necessary as there was relatively little experience locally or national evidence available to inform how telecare can be used to manage risks for the very vulnerable people who make up Social Services primary client group. There was also a need to understand the extent to which the department, on behalf of the County Council, should promote telecare as a preventative measure to people whose needs and circumstances are such that they are not eligible for funded social care.

The Hampshire project has to date focused on identifying suppliers of telecare and learning about the range of products available. The work begun on providing equipment to older people and on gathering their views, will support the next phase of the project - assessing the extent to which the products meet the needs of vulnerable people. This interim report looks primarily at the claims of suppliers to identify how telecare equipment can meet the needs of vulnerable older people.

Further work is needed with older people to test out these claims. Based on the product claims, we can determine that telecare `helps manage' situations where people will be most at risk of harm. It does not replace the need for people to have social contact, an important part of social care provision, nor can it provide personal care such as help with dressing, washing and eating. This would seem to indicate that, for Social Services funded clients, telecare needs to be part of a package of care and support and enhances rather than replaces services. Telecare, when reliable, improves the quality of care by speeding up responses to emergency situations and by detecting changing patterns of activity that may suggest deterioration in health and well-being. In this way, it may give people the confidence to want to remain independent at home or in other settings better suited to their needs.

Pilots started elsewhere in the country are using telecare as part of rehabilitation services for social services clients or as preventive approaches for the general (older) population. For vulnerable people, interim care in a residential setting to `get used to' telecare followed by telecare at home, with or without care depending on need, would appear to be a successful model.

The early evidence from the UK pilots suggests telecare supports and complements current services and gives `added value'. More needs to be learned from experience by users, carers and commissioners before it is likely to be trusted to replace existing services as proposed by the Department of Health.

4. Recommendations

The Department should:

1. Develop a Telecare Strategy with partners

Build on the progress to date of the Telecare Project through the development of a Telecare Strategy with its partners in health, district councils, the

voluntary sector, and user and carer groups. This should set out clear

strategic commissioning intentions and should include:

i. Aims and objectives of the partners' involvement in telecare.

ii. A protocol for partners working together regarding objectives, outcomes, funding, timescales, responsibilities, risks and liability.

iii. The development of service specifications for the provision of equipment, response services and maintenance services, and the requirement for providers to demonstrate their capacity to deliver. This should include the installation and maintenance of equipment to agreed timescales and, where possible, evidence of providers' track record including independent evidence of customer satisfaction.

iv. Identification of the outcomes we expect telecare to deliver.

2. Use the Preventative Technologies Grant in line with the Strategy

Use the Strategy to inform the use of the forthcoming Preventative Technologies Grant, which should be ringfenced for this purpose.

3. Develop the steering group

Reconstitute the steering group to include wider representation in line with the

telecare strategy. This could include users, carers, care management, home

care, occupational therapy, district councils and health. Consider having both

a high level steering group and a project group, which carries out the work.

Ensure the group has the capacity to undertake its work through the retention

of the Telecare Project Co-ordinator post.

4. Increase the evidence base

Continue to gather information for a full six months as per the data set attached as Appendix 2 with a view to commissioning an evaluation of the experiences and outcomes for service users and carers.

5. Continue to identify who will benefit from telecare, giving older people the chance to test it out

Work with partners to:

i. Build on the work to date of identifying which client group or groups are best supported by telecare through the development of user criteria and the work that has been undertaken in case finding with the Innovations Project. This is to include clients who meet the Social Services eligibility criteria and those who do not but would benefit from a more preventative use of telecare, reflecting the aims of the Green Paper.

ii. Identify ways of enabling older people to try out telecare e.g. through the establishment of demonstration sites or projects like the Columba Project in Surrey.

iii. Identify older people who would be willing to "test" telecare equipment in their own homes or in other services (e.g. at day centres) for its robustness, ease of use and usefulness.

6. Raise awareness

Raise awareness of telecare amongst staff and elected members, partners,

potential users and the general public.

7. Participate in opportunities

Continue to participate in national and European opportunities to keep

informed about wider developments in telecare and to influence policy

direction to benefit the residents of Hampshire.