Professor James Ferguson, Professor of Remote Medicine, Robert Gordon University Clinical Lead, Scottish Centre for Telehealth and Telecare Consultant Surgeon in Emergency Medicine, NHS Grampian

Technology Enabled Care in Scotland: The test tube for Europe?

Scotland

Scotland

“Why doesn’t everyone do this?” Telemedicine “Why doesn’t everyone do this?”

Scottish Telemedicine Action Forum (STAF) Assessment of new projects Evaluation of current projects Designed healthcare RARARI SIGN Clinical effectiveness Co-ordination Source of expertise Collaboration Cost efficiency Scottish Telemedicine Action Forum (STAF) Website Database Set National Standards - Clinical - Technological Workshops Symposia ‘Sharing of ideas’

A&E Department, Aberdeen Royal Infirmary. 14 Community A&E Units >1600 A&E consultations in 1 year Increasing rate of usage with time A&E Department, Aberdeen Royal Infirmary.

KERR REPORT

Kerr Report 2005 ensure sustainable and safe local services; view the NHS as a service delivered predominantly in local communities rather than in hospitals

Pilots

Telehealth in Scotland 4 National Programmes: stroke, paediatrics, mental health COPD Underpinning activities: - Technology standards - Workforce development - Stakeholder engagement - Convergence with telecare

COMMUNICATIONS

Scotland

Scottish Centre for Telehealth and Telecare National Telehealth & Telecare Programmes established by Scottish Government in 2006 Parallel programmes but increasingly integrated activity SCT joined NHS 24 in April 2009 Merged in April 2010 into SCTT within NHS 24

Organisational Development

The Healthcare Quality Strategy for Scotland: Effective The most appropriate treatments, interventions, support and services will be provided at the right time to everyone who will benefit, and wasteful or harmful variation will be eradicated

Mission: To Create CHAOS The Enemy - SLOTH Secret League Opposed To Health Mission: To Create CHAOS

CHAOS Choose Hospital Admission as Only Solution

Creating CHAOS Which environment will do the following? Increase Inpatient mortality by 20% Increase Inpatient Length of Stay by 1-3 days Increase likelihood of errors Increase complaints and litigation.

Emergency Department Crowding

ED Door to medical team time 30-day adjusted mortality P < 0.0001

Dying Well 86% public wish to die at home 12% of patients actually die at home. “In treating death as a type of illness, our system of technological, life prolonging medical care is failing to meet the needs of patients, who have priorities beyond survival at any cost” Atul Gwande 2015

RESEARCH

Technology-Enabled Care (TEC) Programme Background Tied to Health & Wellbeing Outcomes Designed to significantly extend the numbers of people directly benefiting from technology enabled care and support in Scotland : Local areas challenged by the Cabinet Secretary to show how technology enabled care contributes to avoiding unnecessary hospital admissions, reduces length of stay and prevents delayed discharges from hospitals in all locations across Scotland. 5 Key Workstreams identified for funded along with an additional overarching Improvement Programme

Five priorities for the TEC Programme Extending the use of home health monitoring Expanding use of video conferencing across all health and social care sectors, as well as growing its use for clinical/practitioner consultations Building on the emerging national digital platforms to enable direct access to advice and assistance Expanding the take up of Telecare with focus on prevention, points of transitions in care and dementia Exploring the scope and benefits of switching from analogue to digital