Cross-Cutting Telehealth Programme Outline that I will be describing the journey from Traditional Approach to Multi Matrix Model 2011 to date PCT to NHS England Paul Marriott TECS Lead Consultant NHS England Strategic Clinical Networks.  TECS Clinical Advocate to NHS England & AHSN NENC Telehealth Programme Lead NENC

AHSN Programme of Cross-Cutting Themes Respiratory \ COPD Fractures Mental Health AF Medicines Optimization Elderly Care We are seeking to use new and existing technology to innovate, pioneer and ultimately share with the health economy what we learn in using Technology Enabled Care Services (TESC) in the pinch points within these and many other clinical pathways across the North East and North Cumbria.

Paul Marriott TECS Lead Liz Allan Pathway and Communications Rachael Forbister Sunderland CCG Pathway Development Jackie Smart Florence Application The Resource and Team

Tripartite Programme and Partnership North England TECS Capability

Cross-Cutting Telehealth Programme

What is Technology Enabled Care Services TECS? Telehealth is the delivery of healthcare at a distance using electronic means of communication usually from service user to clinician e.g. a service user measuring their vital signs at home and this data being transmitted via a Telehealth monitor to a clinician Telecare is the continuous, automatic and remote monitoring of real-time emergencies and lifestyle changes over time in order to manage the risks associated with independent living Telemedicine is the delivery of healthcare at a distance using electronic means of communication – usually from one clinician to another e.g. a non-specialist GP undertaking an ECG on a patient suspected of heart disease and the transfer of that data electronically to a specialist clinician for discussion/comment. E-Health is health services, information and education delivered or enhanced through the internet and related technologies. E-Health encompasses Telecare, Telehealth and Telemedicine M-Health is Mobile health monitoring where a patient can be monitored away from home via mobile technologies 3G SMS and 4G and Apps

Whole System Demonstrator 1st & 2nd Generation Telehealth

2nd Generation Telehealth Added Cloud Services

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 It is essential that it is recognised clinicians will not entertain a system that seeks to place a square peg in a round hole

The Multi Matrix Telehealth Model Seeks to Cross the Whole Life Perspective by Proportionally Matching Telehealth Systems with the Patients Needs, Lifestyles and the Clinicians Medicine. Death Whole Life Perspective Premature Death Irreversible Illness Chronic Illness Signs of Illness Average Health Good Health Robust Health Optimum Health Conception

NHS Florence SMS Simple Telehealth System Specialist Clinicians Prompts and advice GP Practices Community and Specialist Nursing Public Health And the 3rd Sector Local Authority Control Room and Adult Social Care

NHS Florence Simple and Instinctive For Patients Who Can Not Use SMS There is a WHZAN Solution

Annual Average Cost Per Patient by Generation of Equipment Type 1st Year Capital Purchase Cost Annual Leasing Cost Annual Maintenance Cost Total 1st Generation Purchased System £2000 £1000 £3000 2nd Generation Leased System £1150 3rd & 4th Generation Rapid Deployment Leased System £365 SMS Florence System NHS Owned £45 £29 £74

Example of Current Telehealth Pathway Costs Pregnancy Induced Hypertension £1.20 First Week Subsequent Weeks £0.96p P/P Gestational Diabetes £4.72 P/P

Some of the Current Pathways within the North East Programme (there are now over 150) Condition Clinical Lead Heart Failure, Angina etc. FT, GP COPD and Respiratory etc. FT, GP Hypertension GP Diabetes FT, GP Gestational Diabetes FT Pre Pregnancy HbA1c Family Planning FT Parkinson’s FT Rapid Discharge FT Deprivation Medicine and Social Prescribing GP and 3rd Sector Acquired Head Injury and Stroke FT, GP Primary Care Step Up Step Down GP Care and Nursing Home GP Weight Management FT, GP, LA & PH Smoking Cessation LA & PH Remote Wound Dressing Monitoring FT Community Matron Case Load FT Alcohol Induced Morbidity FT FT = Foundation Trust GP = General Practitioner LA & PH = Local Authority & Public Health Example of the 100 Pathways Created to Date

Some the Recent highlights:   Over 150 live pathways developed spanning from Breast Feeding and Gestational Diabetes to COPD, HF and End of Life. Pregnancy Services commenced at City Hospital Sunderland and the pathway is now live in 5 FT’s in the NE with 8 further FT’s scheduled to adopt the pathway and system across the UK in Summer 2015. A recent CQC Report at City Hospital Sunderland published 25th January 2015 stated that the “Telehealth Services were adjudged as Outstanding.” “The use of the Tele-health system in maternity services enabled women to monitor blood glucose levels and blood pressure in their own homes avoiding unnecessary visits to hospital.” CQC City Hospital Sunderland January 2015 
 There has also been a cost saving in clinical practice identified with Pregnancy Services of around £200 per patient per week. Patient satisfaction survey shows between 98% and 100% approval.

Potential Test Bed Status Bringing the Partnership Together of Multiple Organizations Across the North And Combining the TECS I.P. of County Durham and Darlington NHS Foundation Trust with its INR and Nutrition Programmes with that of the NHS England and AHSN NENC Telehealth Programme we have a huge head start.

A Final Thought About Ascent of TECS in NE&NC 1st Generation Telehealth 2nd Generation Cloud Based Telehealth 3rd Generation Mobile Telehealth 4th Generation Linked to NHS Spine 5th Generation Wearable Technology And Beyond

Contact Details Paul Marriott   TECS Lead Consultant NHS England Strategic Clinical Networks.  TECS Clinical Advocate to NHS England & AHSN NENC Telehealth Programme Lead NHS England Northern Senate Waterfront 4, Goldcrest Way Newcastle upon Tyne, NE15 8NY Mob: 07779816519 paul.marriott@nhs.net marriott.p1@sky.com www.england.nhs.uk AHSN North East North Cumbria Biomedical Research Building Campus for Ageing and Vitality Nuns’ Moor Road Newcastle upon Tyne NE4 5PL www.ahsn-nenc.org.uk

Workshop Activity Can you think of your area of work and specialism and write down the “Pinch Points” or areas you think could benefit from the use of TECS (Telehealth)? Can we now use the remaining time to discuss your thoughts?