Marlene Harkis Development manager Scottish Centre Telehealth and Telecare/NHS24

What is SmartCare What does it aim to do How is it going to do it Progress so far Next steps

SmartCare in Scotland aims.. “to improve the health, care and wellbeing of 10,000 people aged 50+ within Ayrshire and Clyde Valley, by enabling a better co-ordinated and more effective approach to falls prevention and management … focusing on the role that ICT services and applications can play in supporting integrated care ”

Current falls impact on Scottish System → Falls & the consequences of falls are a major and growing concern older people/carers/health & social care providers Falls are the leading cause of accident related death in older people (WHO, 2004) and are a common problem amongst older people with long term health conditions Falls and fractures result in over 18,000 unplanned hospital admissions and 390,500 bed days each year in Scotland (ISD 2010/11). This is greater than average stays for COPD admission in the same age group 30% of population aged and 45% of those aged 80+ fall annually (DoH 2009) = absolute risk of 0.34 falls per person for those aged 65+ 1% of falls result in hip fracture = over 6,000 hip fractures in Scotland p.a. The acute management of hip fractures costs NHS Scotland £73m+ p.a. 20% of older people who sustain a hip fracture die within 6 months (SIGN 2009), half will never be functional ‘walkers’ again (WHO, 2004) Falls are one of the leading causes of Emergency Dept attendance and are implicated in over 40% of Care Home admissions (BGS,2001) There are clear links between prevalence of falling & chronic diseases (BMJ 2003) ………………………However, falls are NOT an inevitable consequence of old age!! (Cochrane Review 2012 etc)

SmartCare in Scotland  SCTT/NHS 24 has a national responsibility in Scotland as advisor, facilitator and promoter of technology enabled health, care & wellbeing for 5.2m population  SmartCare overarching pop – 1.1m (20%)  Involving 7 local authorities (22%) – social care/housing/education  3 territorial Health Boards (21%)  Range of voluntary, charitable & independent sector organisations

Intense support Rehabilitation and enablement Staying independent Community wellbeing 6 Hospital or care home Increasing Frailty User Stratification

How Fill the gaps Improve existing processes and communication Promote prevention Collaborate with service users and carers Use technology to improve existing self assessment tools – triage – MFA Implement SmartCare concept

Concept/Model Person ProfileDiary/ Calendar Community engagementIndependence and enablement

Community Engagement Signposting- local services, events social network social networking Keep in touch- Skype family and friends Prevent isolation – keep active – be part of something

Independence and enablement Self assessment fast access to telecare –&equipment Basic screening information Triage tool Multifactorial assessment inform multidisciplinary assessment and hospital admission Intervention record Personal targets Apps for exercise, personal targets diet, games

Diary/Calendar Diary - enhance coordination Co ordination - Persons needs will be varied according to LTC and level of independence Pull together key events supports Link with agencies- GP Hospital appointments Adapting existing systems – home care- EquipU

Person profile Who am I – how do I want things organised Person held information – input practitioners Key Information Summary Health info Social info Comprehensive Integrated information system Influenced and tested by SmartCare

What changes Present Access varied Info dispersed resource led Response varied Redesign Single entry One place Outcome focused Response consistent

Benefits More effective sharing of information Better coordination of care More effective use of technology Quicker assessment – access to resources Increased self management Early identification Sustainable solutions

Progress Falls pathway redesign – service specification Key partners are contributing to the design Users and carer reference group Increased awareness of SmartCare Objectives Concept/technology is being defined National events in October and January + Local events. Local governance arrange meetings – Boards

Next steps Progress Service Specification Continue to Raise awareness of SmartCare Partnership with suppliers and Academia Complete specification Tender implement