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1 1 Paul Marriott MA FCMI TECH Eng IME Telehealth Project Manager NHS South of Tyne and Wear

2 My Background 1977 Started career as an Engineer in Heavy Industry in the North East and progressed as a Divisional Manager in Staffordshire and then the Greater Manchester region. 1995 moved into Local Government as a Senior Manager implemented Telecare, Telehealth, and Ran Sheltered Housing and the 24hr Community Alarms Services. July 2011 formed own Telehealth Telecare Management Consultancy. In August 2011 was contracted to lead the South of Tyne and Wear NHS Telehealth Project.

3 The Workshop M-Care as a Scalable Patient Self Care Solution The Department of Health is rolling out the ‘3 Million Lives Initiative’ which will see a rapid expansion in the use of Telehealth and Telecare Services over the next five years. The Workshop is to look at M-Care and hear how as an example it is being adopted in Multiple Pathways in the South of Tyne and Wear NHS

4 The Definition of M-Care M-Care is Mobile health /care monitoring where an individual can have their health and/or wellbeing monitored at or away from home via mobile technologies such as 3G, SMS, Mobile Apps and the now imminent 4G technologies.

5 M–Care The Demographics The original Telecare/health idea came about because of the growing prevalence of telephone lines across the UK. Beginning with1G telephone lines then moving to 2G Broadband Enabled lines, and then onto 3G Mobile and now 4G Technologies are in the wings 1G and 2G Technologies were the automatic choice as ownership of a landline increased rapidly during the second half of the 20 th Century but has subsequently declined as many people and entire households have chosen to use mobile telephones for all their communication needs In 2010, there were more households in the UK with a mobile phone and no landline than households with a landline but no mobile phone The percentage of people with a mobile phone continues to increase with the fastest growth now for people aged 65 and over

6 The usability of mobile phone handsets has been one of the most significant obstacles to increased ownership and use amongst the oldest people in society There are now many designs of mobile phone that could be used for mobile alarm applications by older or disadvantaged groups Smaller size Large digits Fast-dial keys Large and high-contrast displays Voice activation Evolving 3G Telephony

7 Limitations of Current 1 st & 2 nd Generation Technologies in Health and Care Provision Telecare services provide reassurance and assistance for vulnerable people and their families, especially for people who live alone However, they are limited in their scope because they operate exclusively in the home and its immediate vicinity A basic problem is some people can become concerned about going outside having experienced illness or post accident such as a fall. They may be inclined to stay at home rather than re mobilising which could help improve their health and quality of life Also: What about Patients who have long term conditions who are also long term well and wish to work, and not having to be at home completing daily health checks?

8 Examples of M-Care Devices NHS Florence SMS System bespoke algorithms promotes Self Care whilst critical breaches or alerts goes to supervising clinician Rapidly Deployable 3&4G Blue tooth Tablet based system with bespoke algorithms breaches or alerts goes to supervising clinician Care/Nursing Home Multi User Telehealth bespoke algorithms breaches or alerts go to supervising clinician or Clinical Contact Centre Health/Care Hub devices are beginning to emerge that can interface comprehensive Health and Care Packages working with both Telehealth and Telecare peripheral devices along with Mobile Phones and Mobile Apps. 4G will only accelerate this interface and development.

9 Current 3G and Expected 4G Coverage in the UK

10 How the South of Tyne & Wear NHS and the 3 SOTW Local Authorities are Currently Approaching M-Care

11 South of Tyne & Wear Northumberland Durham South of Tyne & Wear has: Population of around 644,000 3 - Foundation Trusts 3 - PCT’s / CCG 3 - Metropolitan Councils Sunderland, Gateshead and South Tyneside 3 – Telecare/Telehealth Control Rooms

12 South of Tyne and Wear Project Approach The Project is to run until 31 st March 2013 Overall Control of the Project Rests with a Telehealth Project Board Chaired by a Clinical Director Pathway Officers Appointed/Seconded in each of the 3 Sub Regions to develop Clinical Pathways with Lead Clinicians Pump Priming Funding Available in Each Sub Region Until March 2013 The University of Hull (Post Graduate Medical School) have been engage to add academic rigour to the reported outcomes No Single Equipment Procurement Exercise WHY?

13 SOTW Telehealth Clinician Led Not Procurement Led “Practitioners are bloody minded and practice their own medicine following their beliefs and clinical training. If something does not fit with their medicine then they will simply not follow it.” Dr Hussien El Shakankery GP SCCG Urgent Care Clinical Lead

14 So We Match Clinicians Medicine with Pathways, and Then and Only Then, The Equipment Structure of the Telehealth Pilot Team

15 Within the South of Tyne & Wear NHS We are Currently Working on the Following M Health Applications ConditionClinical Lead  Heart Failure, Angina etc.FT, GP  COPD and Respiratory etc.FT, GP  HypertensionGP  DiabetesFT, GP  Gestational DiabetesFT  Pre Pregnancy HbA1c Family PlanningFT  Parkinson’sFT  Rapid DischargeFT  Deprivation Medicine and Social PrescribingGP and 3 rd Sector  Acquired Head Injury and StrokeFT, GP  Primary Care Step Up Step DownGP  Care and Nursing Home GP  Weight ManagementFT, GP, LA & PH  Smoking CessationLA & PH  Remote Wound Dressing MonitoringFT  Community Matron Case LoadFT  Alcohol Induced MorbidityFT FT = Foundation Trust GP = General Practitioner LA & PH = Local Authority & Public Health

16 The SOTW Telehealth Model Uses any Configuration 1 st Generation Vital Signs (Home Based) 3 rd & 4 th Generation Vital Signs / Patient Self Care (Home Based and Mobile Rapid Deployment) 3 rd & 4 th Generation Vital Signs and Patient Self Care (Home Based and Mobile) GP Practices Specialist Clinicians Community and Specialist Nursing Monitoring Centre or 111 Care/Nursing Home Multi User Telehealth Wound Sense


18 SOTW Telehealth Equipment Provision Annual Average Cost Per Patient by Generation of Equipment EquipmentType 1 st Year Capital Purchase Cost Annual Leasing Cost AnnualMaintenanceCostTotal 1 st Generation Purchased System £2000£1000 £3000 2 nd Generation Leased System £1150 3 rd & 4 th Generation Rapid Deployment Leased System £365 3 rd Generation M Care SOTW Florence System NHS Owned £45£29 £74


20 M-Care In Public Health Working with the Local Authority Telecare Control Rooms M-Care NHS SOTW Florence System South Tyneside Council’s Jontek 3G Control Centre Smoking Cessation Weight Management Exercise Depravation Medicine

21 As an Example Deprivation Medicine Pathway GP Recovering Substance User 3 rd Sector Patient Buddy M-Care NHS SOTW Florence System South Tyneside Council’s Jontek 3G Control Centre

22 Paul Marriott Telehealth Project Manager NHS SOTW 0191 5297044

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