1. A STRATEGIC APPROACH TO THE WIDE-SCALE IMPLEMENTATION OF ASSISTIVE TECHNOLOGY: THE SCOTTISH TELECARE DEVELOPMENT PROGRAMME 2006-2011 Dr Gary Fry CIRCLE University of Leeds IFA 2012, Prague, May 2012

2. Future challenges Number of people of pensionable age in Scotland projected to rise from 1 million in 2008 to 1.3 million in 2033 (GROS 2009) With nearly two thirds over 65 suffering 1 limiting illness and over a quarter over 75 suffering 2 or more, there is a great need for appropriate health and social care Providing care will involve a greater emphasis on care given by family, friends and neighbours. New approaches are likely to be adopted

3. Telecare solutions Scottish government has developed initiatives to tackle long term health and social care needs Joint Improvement Team (JIT) established (2004) to work with Scottish local partnerships, with key strategic aims: patient centred care, joint assessments of carers and dependents, ‘joined up’ health and social care services, and the use of telecare to:  reduce need for home care  delay admissions to residential care  reduce hospital admissions and delayed discharges from hospital Telecare was also expected to lead to cost savings for health and social care system

4. The programme From 2006-2011, JIT supported Telecare Development Programme (TDP), investing over £20 million  Local partnerships bid for funding, based on strategic plans  JIT supported local partnerships to develop telecare schemes Delivering Assistive Living Lifestyles at Scale (DALLAS) (2012-2015), with NHS24 / Scottish Centre for Telehealth and Telecare commissioned to deliver in Scotland

5. Implementation of telecare services (1) Some partnerships had already implemented telecare and used TDP funds to develop their services Some resistance in health and social care system to develop new models Lack of knowledge / awareness among health professionals (particularly GPs); resistance to telecare among some care workers (Jarrold and Yeandle, 2009) Limited, inconsistent or poor project management Limited understanding / skills to redesign service Successful local partnerships had established policies for installing telecare and identifying target groups (Boddy and Henderson, 2009)

6. Implementation of telecare services (2) The Sergeant Review (2010): All partnerships moving telecare to mainstream provision Many integrating it into existing services Most using social services to enable clients to access it and had adapted needs assessment procedures All explored its use to support a wide range of groups Issues impeding progress:  problems with suppliers / equipment reliability  difficulties in recruiting / training staff  limited commitment from senior management  undeveloped management systems

7. Numbers of service users From 2006-2011, 43,000 people accessed a telecare service In 2010/11, over 14,000 new clients received a telecare service, though 6,000 stopped. Growth for this period was over 8,000 new users Two-thirds of clients are female and most aged over 65 Proportion of clients younger than 65 receiving telecare has increased over time, as has the proportion of people with dementia or a physical disability (Newhaven Research, 2011)

8. Impact assessments Concerns expressed by carers: Knowledge about the types of telecare equipment available was limited among service users and professionals Even with telecare in place, carers need home care services Telecare sometimes added to stress if client would / could not use equipment Benefits to carers: Improvements in health and well-being (“a good night’s sleep”) Enhanced ability to care, and (in some cases) to combine work and care Less stress (though small number felt stress levels had increased) Telecare gave ‘peace of mind’ (Jarrold and Yeandle, 2009; Beale et al, 2009)

9. Impacts on health and social care system Hospital bed savings due to reduction in delayed discharges was lower than expected in 2006-11, but in 2010/11 exceeded expectations (as defined by government in strategic review) Hospital bed savings due to reduction in unplanned hospital admissions exceeded expectations for both 2006-11 and 2010/11 Number of home check visits saved was below expectations, but still a considerable figure (450,000 between 2006-11) Figures show that in 2010/11 telecare achieved most expectations, suggesting it has become embedded in health and social care system (Newhaven Research, 2011)

10. Financial benefits Financial benefits in 2010/11 estimated to be over £30 million. The value of benefits arising from telecare expenditure from start of programme estimated to be £79 million Nearly half of all savings arose from avoidance of care home admissions, with a similar figure arising from avoiding hospital stays (Newhaven Research, 2011)

11. Conclusions From 2006-2011, the Scottish Government supported telecare services with a significant financial investment Some partnerships performed more successfully than others, drawing on experience, support of senior staff, and effective strategies to engage service users / professionals Most carers claim that telecare results in greater confidence and improved health and well-being Some carers / professionals lack knowledge about telecare, with limited access to equipment Most do not consider it a replacement for other forms of care Telecare reduces admissions to hospitals / rest homes and reduces numbers of home checks Telecare has a beneficial impact on health and social care system in terms of cost efficiencies

12. Contact CIRCLE and key reference Please address any enquiries relating to CIRCLE or this presentation to Dr Gary Fry: g.fry@leeds.ac.uk g.fry@leeds.ac.uk ICT-based solutions for caregivers: assessing their impact on the sustainability of long-term care in an ageing Europe http://is.jrc.ec.europa.eu/pages/EAP/eInclusion/c arers.html http://is.jrc.ec.europa.eu/pages/EAP/eInclusion/c arers.html Funded by the Institute for Prospective Technological Studies, European Commission