Archived decisions

    Hampshire County Council

    Executive Member - Adult Social Care Item 1

    30 September 2005

    Telecare Interim Evaluation and Next Steps

    Report by the Director of Adult Services

    1

    Summary

       

    1.1

    The following decisions are sought:

       
     

    1. The Executive Member notes the Telecare Interim Evaluation

    2. That approval be given to the recommendations contained in the Telecare Interim Evaluation

    3. That approval be given to the approach set out for the preparation for the Preventative Technologies Grant

       

    2

    Reason(s)

       

    2.1

    This decision supports:

    Aim 1 of the Corporate Strategy [Maximising Life Opportunities] by enabling more older people to remain independent for longer,

    Aim 4 of the Corporate Strategy [Building Strong and Safe Communities] by enabling older people to summon help when they need it either from friends or family, as well as alerting community alarm services,

    Aim 5 of the Corporate Strategy [Improving Services] by meeting the changing needs of older people.

       

    3

    Other options considered and rejected

       

    3.1

    None.

       

    4

    Conflicts of interest declared by the decision-maker or other Executive Member consulted

       

    4.1

    None

       

    5

    Dispensation granted by the Standards Committee

       

    5.1

    None

    6

    Reason(s) for the matter being dealt with if urgent

       

    6.1

    Not applicable

    Approved by:

    ..........................

    Date:

    .........................

     

    Councillor Patricia Banks

       

    Hampshire County Council

    Executive Member - Adult Social Care

    30 September 2005

    Telecare Interim Evaluation and Next Steps

    Report by the Director of Adult Services

    How the conclusion in this report fits with the Corporate Strategy

    This scheme will impact on the delivery of the following Corporate Aims:

    The use of telecare will enable more older people to remain independent for longer, therefore maximising their life opportunities, Aim 1 of the Corporate Strategy.

    Telecare enables older people to summon help when they need it, often from friends and neighbours, as well as alerting call centres when there is the possibility that something is wrong. It therefore contributes to Aim 4, Building Strong and Safe Communities.

    Finally, the use of telecare will contribute to the improvement of services, Aim 5 of the Corporate Strategy.

    1.

    Summary

       

    1.1

    Telecare can be defined very simply as detectors or monitors (eg motion or falls detectors), usually linked to community alarm systems, which can trigger a warning to a control centre that can then be responded to. The equipment includes pendant alarms, flood detectors, gas detectors and sensors. Some forms of telecare gather information about the person's levels of activity.

    This report briefly outlines Hampshire's telecare pilot projects, summarises the interim evaluation and outlines its recommendations. It also provides information about the forthcoming Preventative Technologies Grant and sets out the emerging approach for its use.

    There are three appendices to this report. Appendix 1 is a summary of the interim evaluation, Appendix 2 is a sample of case studies from the pilots and Appendix 3 is a draft budget for Year One of the Preventative Technologies Grant. The full interim evaluation will be placed in the Members Room.

    2.

    Impact Assessment

       

    2.1

    In compiling this report account has been taken of the requirements of the Corporate Equalities Plan and Race Scheme. An impact assessment has been carried out. Telecare will be available to all people in Hampshire including people from minority ethnic groups, and could possibly contribute to providing a more sensitive service to people from minority ethnic groups.

    3

    Consultation with Local Members

       

    3.1

    None

    4. Introduction

    4.1 Telecare can be defined very simply as detectors or monitors (eg motion or falls detectors), usually linked to community alarm systems, which can trigger a warning to a control centre that can then be responded to by either named family or friends or by a response service. It includes pendant alarms, flood detectors, heat detectors and sensors. Some systems can also monitor people's activity levels.

    5. Hampshire's Telecare pilots

    5.1 Hampshire County Council has had an active interest in telecare for over three years. It has invested in telecare equipment, which it has piloted with a number of older people in their own homes, and has a dedicated Telecare Project Co-ordinator located in the Older People's Strategic Team.

    5.2 The County Council has worked in partnership with district councils, housing providers, health, control centres and users and carers to develop its knowledge base.

    5.3 Developments have been guided by the Telecare Steering Group, which has overseen the pilots, commissioned the evaluation and provided local knowledge.

    5.4 Three types of telecare equipment have been piloted: the Insight system manufactured by Huntleigh, the Wisehome system manufactured by Tunstall and the Wristcare system distributed by Vivatec.

    5.5 Hampshire was initially interested in the Huntleigh Insight system (originally known as Millennium Homes) which used sensors to monitor a person's activity. The information was fed to a computer, which was in turn linked to a telephone or loudspeakers which could alert the person if there was anything out of the ordinary. Unfortunately this system was not robust and Hampshire stopped using it earlier this year.

    5.6 Hampshire has also evaluated the Wisehome system manufactured by Tunstall. This is a home unit with a range of personal alarms and detectors including flood detectors, gas detectors and pendant alarms.

    5.7 The final system Hampshire has piloted is Wristcare, distributed by Vivatec. This is a wristband which has built-in sensors to monitor the wearer's wellbeing. It has manual and automatic alarms which can link into any alarm control centre. It also collects activity data for the person so it can be demonstrated how active someone is and how well they are sleeping. Case studies of how both this and the Tunstall system have been used can be found in Appendix 2.

    6. Interim Evaluation

    6.1 The Interim Evaluation of Hampshire County Council's telecare pilots was commissioned by the Telecare Steering Group in the autumn of 2003 and carried out by Carole Bennett of the Performance Monitoring Unit. A summary of it can be found at Appendix 1 and the whole report is available in the Members Room.

    6.2 The Interim Evaluation gathered information from Hampshire's telecare pilots as well as mapping what equipment is available, what its uses are, locating the policy context and looking at other schemes taking place both nationally and internationally.

    6.3 It found that Hampshire has so far focused on identifying suppliers of telecare and learning about the range of products available. It has also taken time to establish what the component parts are for a telecare service, including response centres, maintenance arrangements and prompt equipment provision. There have been some issues with the reliability of products and the capacity of providers, although this is not the case with all products. More time and more numbers are needed to assess the impact on service users.

    7. Interim Evaluation Recommendations

    7.1 The Interim Evaluation set out seven recommendations. These are to:

      · Develop a telecare strategy with partners

      · Use the Preventative Technologies Grant in line with the strategy

      · Develop the steering group to include wider representation in line with the strategy

      · Increase the evidence base by continuing to gather information for a further six months with a view to commissioning an evaluation of the experiences and outcomes for service users and carers.

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

      · Raise awareness of telecare amongst staff and elected members, partners, potential users and the general public.

      · 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

    7.2 It is proposed that these recommendations are adopted and that they set the framework for future work.

    8. Preventative Technologies Grant

    8.1 The Preventative Technologies Grant will be available nationally over two years from April 2006. £30m will be available in the first year and £50m in the second year. It will be allocated using the Formula Spending Share for Older People.

    8.2 The Grant conditions and indicative amounts will not be released until January 2006. However, it is anticipated that Hampshire County Council will receive around £500,000 in the first year. The Department of Health has already developed supporting documents through a national Policy Collaborative, which Hampshire County Council officers have contributed to. There are therefore some clear messages about how the Grant should be used.

    8.3 The aim of the Grant is to increase the number of people who can benefit from telecare services in order to help them to remain independent. The Government expects that 160,000 older people will benefit nationally, which translates to around 3,200 older people in Hampshire. It anticipates that by providing telecare equipment there will be a transformation in the design and delivery of health and social care services, although it must be stressed that there is not yet a strong evidence base for this.

    8.4 The Grant is expected to be used in partnership to provide an integrated health, housing and social care service. Key partners include housing providers, health, police and fire services, equipment suppliers, the independent and voluntary sector, and users and carers.

    8.5 The Grant can be used not just for equipment but also for the "hidden" costs of telecare including support costs, maintenance and information.

    8.6 The Department of Health and CSCI will be developing a method of identifying the numbers of people benefiting from the telecare grant. Local authorities and partners have been advised that they may also wish to develop locally agreed targets or outcome measures.

    9. Preparing for the Preventative Technologies Grant

    9.1 The Preventative Technologies Grant is already a very high profile funding stream and a great deal of interest has been generated locally. Hampshire County Council will have to demonstrate how many older people have been helped so it is therefore recommended that an extra £500,000 above next year's FSS is committed for telecare equipment and infrastructure costs. Although the focus of the grant is on older people, adults who could benefit in line with the FACS (Fair Access to Care Services) principles will also be considered.

    9.2 The Department of Health expects plans for the Grant to be made in partnership with housing departments, health, voluntary sector organisations, users and carers. Adult Services will begin this process by holding a workshop this autumn to establish a strategic direction.

    9.3 The County Council can use the findings from the interim evaluation to develop a framework for how the Grant should be used. This will include provision for information, equipment, maintenance, assessment, staff training, commissioning, monitoring and evaluation. It will also build on work on how telecare fits in with other services including home care, ICES, Equipment Direct and the forthcoming Head of Wellbeing post. If the Grant does finish after two years then it will be vitally important that telecare is mainstreamed into existing services as tightly as possible.

    9.4 An initial budget for the Grant is attached at Appendix 3. This is based on available evidence and utilises the Government's telecare documents. A number of different projects will be funded including enabling people to try out equipment through a demonstration site or sites, the extension of the use of Wristcare and the provision of support for people with dementia.

    9.5 Telecare can be used as an enhancement to an assessed service, such as home care, as well as a more preventative service. The FACS criteria will be used as the basis for eligibility as it can cover both groups of people. The FACS criteria will then be used when assessing proposals for schemes to be funded by the Grant.

    9.6 The telecare equipment can be either be part of a service user's care package or the service user can purchase it through a direct payment.

    9.7 It is proposed that the focus of the Grant should be on telecare, rather than telehealth. However, proposals for the use of telehealth will be considered if they can be match funded by local health services.

    10. Future Plans

    10.1 It is not yet clear whether the Preventative Technologies Grant will continue after the two years and so it is important at this stage to consider the options for if it does come to an end.

    10.2 The Department of Health expects large savings to be made through the adoption of telecare as it expects more older people to remain at home and not need residential or nursing care. It has provided two modelling tools to be used to show these savings, and this work would have to be taken into account in future plans.

    10.3 If the Grant ends then there are three possible scenarios. Firstly, if savings can be demonstrated as the Department of Health predicts then the savings can fund the ongoing work.

    10.4 Secondly, if savings cannot be shown then an exit strategy or scaling down of the work will have to be put in place. Telecare equipment is wireless and so can be used again and again, although it would need maintenance and upgrading. There would also be the infrastructure costs of any stand-alone project to consider, although all possible steps will be taken to integrate telecare within existing services.

    10.5 Finally, if savings cannot yet be shown but it appears that future work would show success then this would identified as a cost pressure for the following year.

    10.6 Once the future of the Grant is known then the work so far can be assessed against the above options. If it is decided to disinvest from the work then this would allow enough time for it to take place.

    Appendix 1

    Summary of Interim Telecare Evaluation

    Appendix 2

    Case Studies from the Telecare Pilots

    Appendix 3

    Draft budget for Year One of the Preventative Technologies Grant.

    Recommendation(s)

       

    That:

    The Executive Member:

       

    1

    Notes the interim evaluation of the county's telecare pilots

       

    2

    Agrees the interim evaluation recommendations

       

    3

    Agrees the approach set out for the preparation for the Preventative Technologies Grant

    Section 100 D - Local Government Act 1972 - background papers

    The following documents disclose facts or matters on which this report, or an important part of it, is based and has been relied upon to a material extent in the preparation of this report.

    NB the list excludes:

    1 Published works

    2 Documents which disclose exempt or confidential information as defined in the Act

    NONE

     ***

    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.

    Appendix Two - Case Studies and User Feedback

    Case Study 1

    Mrs K is 89 years old, lives in her own home and has limited mobility as well as being deaf. She has been using a range of Tunstall sensors since June 2004. She has found the falls detector cumbersome (it attaches to a belt) and so wears a pendant alarm. However, on the plus side Mrs K left her gas on and the gas detector alerted her to the situation. On another occasion the microwave shorted and emitted lots of smoke. The smoke detector went off and prevented an emergency.

    Case Study 2

    Mrs W is an eighty nine year old who lives alone in a first floor flat. Until recently she had spent several years looking after her frail husband, this appears to have been her main focus in life, declining formal offers of help until shortly before his death. Within a few days of her loss, Mrs W had an emergency admission into hospital resulting in surgery to remove gall stones. After hospital Mrs W was losing her motivation, was losing weight and withdrawing from social contacts.

    The Project's Social Worker and Community Nurse visited Mrs W to support her through her bereavement, helping her to adjust to new life changes and encouraging her to maintain her physical and emotional well being. A care plan was developed, which included installing a WristCare unit.

    Over the course of the last three months Mrs W has positively responded to the regular contacts, support and especially the time given. She has gained in weight, returned to some of her social activities and enjoys a more positive outlook. Mrs W particularly likes the security of wearing the wristcare alarm and feels more confident when mobilising or accessing her bath, indeed she now walks confidently around her flat. She has become adept at using the wristcare system and states that she likes the secure feeling that it gives her. Furthermore, when the activity data highlighted a change in her night time sequence, the project workers were able to respond immediately, resulting with the project's community nurse visiting Mrs W to discuss the very unsettled night that she had had and giving her advice to help prevent this re-occurring in the future.

    Case Study 3

    Mr T has been using WristCare since April 2005. He lives on his own and his immediate family are not close by. During May he developed pneumonia and a kidney infection. This became apparent on the activity data for that period (graph attached). Mr T fell over several times during this period and each time pressed the alarm and an immediate response was sent. Mr T was extremely grateful for the WristCare and believed it saved his life. The system has also given him confidence and make him feel safer in his own home.

    User feedback

    Interviews with thirteen service users who have been using WristCare for between three and six months have been completed. Their responses are:

      · 9 out of 13 reported that it is easy to take off and put on.

      · 10 out of 13 felt that it was helping them to stay independent.

      · 12 out of 13 felt more confident.

      · 8 out of 13 felt it took the strain off their family

      · 12 out of 13 said it made them feel safer in their own home.

      · 10 out of 13 felt it was not intrusive.

      · All users wished to carry on with the pilot.

    The Project Workers have also been consulted and their views include:

      · 10 out of 11 felt the client's confidence increased (5 significantly)

      · 10 out of 11 felt it gave the client an increased sense of safety (5 significantly)

      · 9 out of 11 felt it increased the client's sense of independence

      · 9 out of 11 thought it had helped the Project Worker (3 significantly)

      · 7 out of 10 have reported that the activity data has been useful. Examples of its usefulness include helping to assess need, highlighting changes in activity levels and detecting a UTI.

    The needs being met are:

      · Feel more comfortable in own home

      · Feel safer in own home

      · Peace of mind for family and carers

    Appendix Three - Provisional Budget for Year One of Preventative Technologies Grant

    Please note that the Grant conditions and allocation will not be published until January 2006 and so the budget is provisional until then. It is estimated that Hampshire will receive £500,000 in the first year.

    A number of projects will be funded. The emerging ideas are set out below but may be subject to change depending on further discussion which will take place during the autumn. All projects will contribute to the vision for Adult Services.

    Item

    Amount

    I WTE Telecare Service Manager

    £50,000

    1 Telecare Project Co-ordinator (3/5 of a post)

    £15,000

    Information provision

    £25,000

    Training

    £20,000

    Equipment - support for people with dementia

    £50,000

    Equipment - through home care service

    £50,000

    Equipment - extension to Wristcare/Innovations Project

    £50,000

    Equipment - Direct Payments

    £100,000

    Equipment - Gosport Extra Care Scheme (DH bid)

    £25,000

    Equipment - link to acute discharges and reimbursement

    £70,000

    Demonstration sites

    £10,000

    Monitoring costs

    £10,000

    Maintenance costs

    £10,000

    Evaluation

    £15,000

    Total

    £500,000