APPENDIX 7
Memorandum by Attendo Systems Ltd (MT
26)
CORPORATE OVERVIEW
Attendo Systems is one of three main business
areas operating within the Attendo Senior Care group, a major
Swedish organisation employing approximately 4,000 people across
Europe. Countries throughout Europe where Attendo have continuing
operations are detailed below.
Group turnover during 2001 was £80 million;
representing a 25% increase on 2000, and in 2002 was c £95
million. Group market share is approximately 40% of Europe, whilst
Attendo Systems currently has a 20% market share in the UK. Following,
a recent acquisition Group turnover is expected to reach £300
million in 2005 making Attendo SeniorCare the fifth largest specialist
care provider across Europe.
Since it was established in 1955, the company
has grown both organically and through acquisitions, including
Cass Electronics and Davis Communications.
The main areas of Group business activity are:
— Activity validation systems
— Installation, maintenance
Attendo Response and Attendo Care are primarily
concerned with provision of care services to the elderly and infirm.
Attendo Care are a specialist care provider operating a large
number of Scandinavian nursing homes providing care services on
behalf of local government organisations.
Attendo Response has established monitoring
centres in a number of European countries (Figure 1) that provide
monitoring and response services in support of the elderly and
infirm.
Attendo Systems work with a number of technology
partners to develop innovative technical solutions and products
for care and security markets. In addition, support of a range
of systems is offered by way of responsive and routine service
and maintenance solutions.
A common aspect of all Attendo business activities
is a partnership approach that aims to provide outstanding levels
of service and value on behalf of our customers. A key feature
being a willingness to "work with" our customers to
ensure ongoing improvement and development of services offered
in line with customer need.
ATTENDO WITHIN
THE UK
Attendo Response (UK) support a number of Housing
Association and Local Authority customers across the UK. In addition,
an established partnership with Help the Aged sees Attendo Response
as sole provider of care-phones to Help the Aged customers, installing
phones on Help the Aged behalf and monitoring calls received from
these customers initiating the most appropriate response to the
call via key-holders, the emergency services etc.
Attendo Systems are able to provide a full range
of products and services to meet the demand for Social Alarm and
Telecare systems and products across the UK and Europe. Our product
range extends across: Dispersed Alarms and associated sensors
and peripheral devices, Warden Call systems, Control Centre systems
and software, Nurse call systems and Door Entry systems.
Our service, maintenance and Telecare support
agreements are designed to support this range of systems and products
to support customers in a varied and flexible way that takes into
account changing demands on telecare systems.
1. SUMMARY
This memorandum attempts to make the case that
technologies are readily available to meet many of the Health
and Social Care policy objectives that have emerged over recent
times. Whether these objectives relate to more cost-effective
use of resources or less tangible ideals relating to identifying
new models of care that will extend the scope for older people
to live independently they can be assisted by systems that can
already be provided in a useable form.
The limitation on uptake of these systems being
explained by an ongoing lack of involvement amongst Health and
Social Care staff in the management and development of Community
Alarm networks and an inability on the part of Health and Care
professionals to understand and recognise the potential of these
systems.
We also contend that academic review of the
different elements of Telecare and Telehealth systems have tended
to view them as disparate solutions rather than complimentary
components that enable care to be delivered directly to the persons
domestic property. This approach has tended to encourage the review
and supply of the systems to be considered along functional lines
with Community Alarm staff responsible for provision of Telecare
solutions and Telehealth being directed toward Health practitioners.
An integrated approach will provide the greatest
potential to develop and enhance community based services and
we have identified a number of steps to be followed before services
based around these technologies develop into mainstream care provision.
2. WHY TELECARE
AND TELEHEALTH?—CHOICE
AND INDEPENDENCE
2.1. Personal aspirations
2.1.1. "The aspirations of older or
disabled people are similar to everyone elses. They want to be
seen as individuals with a range of friendships and relationships;
80% of older people want to live in their own homes; they want
to be independent and to be as healthy as possible; and most of
all they want to be in control of their lives. They do not want
others to define their limitations. AT can support these aspirations
by allowing people to maintain or regain their autonomy, and it
can provide them with the choice of staying in their own homes
rather than having to move into residential care." (Audit
Commission—Assistive Technology—Independence and well
being 2, Why Assistive Technology Matters, Users aspirations,
p.7)
2.1.2. Extract from Audit Commission, Older
Person—independance and well-being the challenge for public
services:
"5. We need a fundamental shift in the
way we think about older people, from dependency and deficit towards
independence and well-being. When they are asked, older people
are clear about what independence means for them and what factors
help them to maintain it. Older people value having choice and
control over how they live their lives. Interdependence is a central
component of older people's well-being; to contribute to the life
of the community and for that contribution to be valued and recognised.
They require comfortable, secure homes, safe neighbourhoods, friendships
and opportunities for learning and leisure, the ability to get
out and about, an adequate income, good, relevant information
and the ability to keep active and healthy."
2.2. National policies impacting Telecare
2.2.1. The National Services Framework for
Older People, Standard 2 calls for:
"NHS and social care services to treat older
people as individuals and enable them to make choices about their
own care. This is achieved through the single assessment process,
integrated commissioning arrangements and integrated provision
of services."
2.2.2. Whilst Section 3 of the NSF suggests
that:
"Older people will have access to a new
range of intermediate care services at home or in designated care
settings, to promote their independence by providing enhanced
services from the NHS and councils to prevent unnecessary hospital
admission and effective rehabilitation services to enable early
discharge from hospital and to prevent premature or unnecessary
admission to long-term residential care."
2.2.3. Preparing Older Peoples Strategies:
Linking Housing to Health, Social Care and other
Local Strategies urges "Social Care and health services to
focus on interventions that will promote independence and provide
care and support close to home rather than through institutional
based services. The change requires flexible and integrated service
solutions across health, social care and housing."
2.2.4. This same document questions the
role of community alarm services and new technology asking:
"are they meshed in as part of the wider
service system? For example, do they complement a health or social
care rapid response service? Is there an integrated `out of hours'
service linking night nursing, rapid response and mobile warden
services using the community alarm service as the emergency contact
point?"
3. CURRENT SITUATION
3.1. It is our contention that technology
to support these objectives is currently available and well proven
in the form of Community Alarm systems and Telehealth systems.
It is our believe that the missing link lies in the need for tighter
integration between cross functional agencies to ensure medical/nursing
involvement to complement Community Alarm and mobile response
services.
3.2. This would take the form of knowledge
based support to enable health monitoring in the home coupled
with introduction of a new perspective to recognise the potential
to introduce more advanced services to broaden the choice and
scope for independence for older people. To date a clear distinction
has been drawn between Telecare systems and Telehealth systems
we believe this to be counter productive and believe that more
needs to be done to ensure these are simply two components in
a package of solutions to enhance community based health and social
care services for older people.
4. TECHNOLOGY
AVAILABILITY
4.1. Technical solutions are available in
the form of:
4.1.1. Community Alarms to allow the management
of risk for people living independently by providing a response
network to deal with alarms raised by the user or alarms raised
via sensors connected to the system designed to alert responders
to: falls, smoke detection, gas leak, low temperature, a lack
of activity within the property and many other potential risks.
4.1.2. Telehealth systems that allow the
remote monitoring of vital signs to provide ongoing assessment
of the users health and well being. These systems also promote
greater patient involvement within the care process.
4.2. Both of these technologies have been
proven over a number of years with the Community Alarms network
well established within the UK and Telehealth systems proven to
be effective through a number of American research studies.
4.3. These systems have, to date, been considered
as separate solutions with the result that the infrastructures
necessary to fully utilise the available technologies have not
yet been established. It is our contention that remotely monitored
care pathways can be designed to support independence for increasing
numbers of the elderly population by utilising these technologies
to support the care of older people in the community coupled with
investment in the support infrastructure to provide nursing/medical
support to existing response and care teams.
5. THE TECHNOLOGY
5.1.1. Simple explanation of the technologies
are provided in the following extract from Audit Commission, Older
Person—Independence and well-being the challenge for public
services:
Telecare
Telecare is provided when a variety of functions
are controlled with various technologies that provide communications
with the outside world. Once telecare systems, electronic ATs
and environmental controls are integrated, the term "smart
housing" is sometimes used to describe the resulting accommodation.
Telecare systems alllow people with a range of needs to retain
their independence through:
— reducing hospital stays, by supporting
earlier discharge;
— virtual visiting, for example, by
monitoring the safety of older people with dementia who live alone;
— reminder systems, such as reminding
older people to take their medication; and
— home security and social alarm systems,
by providing smoke and heat detectors, alarm systems and crime
surveillance, as well as monitors that pick up any unexpected
changes to an older person's routine (refs 21, 22 and 23).
Telehealth
Telehealth (or clinical home monitoring enables
a clinical process to be conducted remotely. It enables routine
monitoring of vital signs to be carried out by people at home.
For example, a chronic disease management service run by the West
Yorkshire Ambulance Service can remotely measures people's blood
pressure, pulse rate and ECG, breathing rate, breathing amptitude,
blood oxygen saturation levels and temperature. People are taught
how to apply the sensors and take readings. Data is automatically
sent to a control centre, where a clinician is alerted to any
variations in the expected readings.
Increasingly, telehealth not only overcomes the
inconvenience of distance, but also provides people with greater
choice and control over the time and the place for monitoring
their condition, increasing convenience and making their conditions
more managable. At the same time, it also reduces some of the
pressures on clinics and actute hospitals. In the USA, for example,
the use of video technology in the home has been found to provide
clinical care for patients with certain condictions of an equal
quality to hospital care and at a reduced cost (ref 24). Telehealth
could make a significant contribution to the management of a number
of chronic conditions, including COPD, heart failure, hypertension,
asthma and diabetes.
5.2. These technologies provide the potential
to provide for safety and security of the older person by monitoring
risks to the well being of the older person. This followed by
instigation of an appropriate response to an alarm condition by
mobile responders, a carer, relative or the emergency services.
A number of risk factors can be identified and monitored by the
use of a range of sensors that can be linked to a social alarm
dependant upon the individuals' personal situation and identifiable
as part of the assessment of the needs of the older person.
5.3. The monitoring of these alarm conditions
can be carried out via existing community alarm networks with
first line response by existing mobile warden services. Preventative
aspects of these Telecare systems include a channel of communication
from the older person to the outside world to help offset potential
feelings of social isolation.
5.4. Having provided as secure and safe
an environment as practical and desirable for the individual concerned
to raise the possibility of independence. These services can then
be complemented, where required, by remote monitoring of the older
persons state of health and well being utilising telehealth equipment.
This allows health professionals to receive feedback on the persons
state of health via measurement of key data on the patients vital
signs such as: heart rate, blood pressure, glucose levels, weight
etc.
5.5. This allows early indication of deteriorating
health, early warning of an adverse reaction to medication and
treatment and directly involves the patient in the management
of their care provision.
5.6. Alarms to warn of measurements outside
pre-set thresholds provide for a responsive aspect to Telehealth
systems in addition to the preventative care management benefits.
5.7. In order to broaden the scope for a
choice of independent living for a greater proportion of the older
population it is essential to consider both modes as part of an
integrated solution in order to provide for people with complex
or changing care needs. Telecare systems become essential to provide
a secure environment from which to introduce more complex preventative
care services.
5.8. Telecare can be used to support a range
of different patient groups as described in Table 1.
Table 1
THE ROLE OF TELECARE IN SUPPORTING DIFFERENT
PATIENT GROUPS
| Patient group |
Role of telecare |
| Chronic disease | Provide facilities to self-manage care at home but allow patients to stay in contact with carers
|
| Increasing frailty | Provides facilities to allow people to remain at home for longer
|
| Disabled people | Increases home safety and security, share risk of independent living
|
| People with learning difficulties | Increases home safety and security, share risk of independent living
|
| Palliative care | Provides facilities to manage end-of-life debility at home
|
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Extracted from Audit Commission, Implementing Telecare, 2004.
5.9. It is also important for Care providers to understand
the potential of these systems to provide a broad range of potential
solutions in the development of care services delivered to the
patients door. The active involvement of the patient in the monitoring
process also encourages patients to take responsibility for their
own care and subsequently encourages greater consideration of
factors affecting their health and well being.
6. SERVICES DEVELOPMENT
6.1. A multi-stage development process is envisaged that
includes the following key stages:
6.1.1 Familiarisation and Awareness -Care professionals
and decision makers need to understand what is available and how
this can be utilised to obtain service delivery improvements and
cost savings.
6.1.2 Local networks of care—ensure systems can
be developed that enable effective care planning delivered by
cross-functional teams of social care and nursing specialists
supported by suppliers.
6.1.3 Semi-integrated Telecare and Telehealth systems—Suppliers
will find it difficult to justify investment in full-blown integration
in the absence of (1 and 2 above). This is described schematically
in Figure 1. With health information made available to key people
within the support structure via web access to a secure server
that sits behind the NHS firewall.
6.1.4 Consultation -Identification of system improvements
and refinements.
6.1.5 Full integration—Merging of Telecare and
Telehealth solutions to ensure they are able to sit on a common
platform in a manner that supports integration of cross-functional
teams.
7.
FIGURE 1
SEMI-INTEGRATED SERVICE MODEL
8. CURRENT UK USER
BASE
8.1. There are to date 1.6 million users of community
alarm equipment within the UK the vast majority of which are "simple"
pendant alarm systems. The vast majority of these systems provided
to support older people.
8.2. The UK user base for Telehealth systems remains
very small. However, these systems are used more extensively across
North America where they have proved invaluable in managing care
in a pro-active manner within the users' home.
8.3. The community alarms user base includes older people
that are:
8.3.1 Living with long-term conditions.
8.3.2 Developing long-term conditions.
8.3.3 Becoming increasingly frail and increasingly prone
to falls and domestic accidents.
8.3.4 Increasingly likely to need extended support and
care.
8.3.5 Familiar with the use of technology and the response
network to support them. As such they are more likely to recognise
the benefits of using technology to maintain their independence.
8.4 The majority of providing agencies have no systems
in place to review and enhance systems provided to these users
in line with the changing circumstances of users of the systems.
Prohibiting factors are believed to be:
8.4.1 Increased complexity of telecare systems—requiring
greater installation to ensure correct siting and configuration
of sensors and equipment etc places this outside the scope of
non-technical staff currently employed to install "simple"
systems. This can be overcome by using supplier and technical
service organisations in holding stocks and providing rapid response
teams to respond to requests for installation of systems against
agreed response times.
8.4.2 Support arrangements are not in place to go beyond
response mode to preventative mode.
8.5 As such, decisions are supply rather than needs led
which:
8.5.1 Inhibits the extension of use of these systems
to provide users with an independent living choice for longer.
8.5.2 Inhibits development of preventative approaches
and risk management, rather than crisis management.
8.5.3 Promotes short-term decisions on equipment supply
for this group with purchases generally price-led with little
or no regard to the functionality and scalability of systems.
This by-passes opportunities.
8.5.3.1 To provide solutions that are directly matched
to initial user needs.
8.5.3.2 To allow solutions to adapt to changing user
needs.
8.5.4 Misses the opportunity to set the precedent for
providing for a broader range of older peoples developing care
requirements within their home.
9. NATIONAL TARGETS
RELEVANT TO
TELECARE
9.1. The Department of Health (DH) report Delivering
21st Century IT support for the NHS outlines targets for telecare
to be available in all homes that need it by December 2010.
9.2. A further DH report National Standards, Local Action—Health
and Social Care Standards and Planning Framework, 2005-06 to 2007-08
establishes a National Target to: "improve health outcomes
for people with long term conditions by offering a personalised
care plan for vulnerable people most at risk; and to reduce emergency
bed days by 5% by 2008 (from the expected 2003-04 baseline) through
improved care in primary care and community settings for people
with long term conditions."
9.3. This same report also established National Targets
to: "improve the quality of life and independence of vulnerable
older people by supporting them to live in their own homes where
possible by:
9.4. Increasing the proportion of older people being
supported to live in their own home by 1% annually in 2007 and
2008; and
9.5. Increasing by 2008 the proportion of those supported
intensively to live at home to 34% of the total of those being
supported at home or in residential care."
10. BENEFITS
10.1. The Audit Commission report "Implementing
Telecare" concludes that the case for a move beyond pilots
and trial telecare projects is compelling. It also agrees with
our view that the basic technology is robust and much less of
a risk than the challenge of getting public services to work across
organisational boundaries. Overcoming this challenge will:
10.1.1. Make independent living a realistic choice for a
greater number of people supporting DH objectives to increase
the number of people supported to live in their own home by 1%
in 2007 and 2008 and the DH objective to provide Telecare in all
homes that need it by December 2010.
10.1.2. Promote joint working and integrated care delivery
plans to support DH objectives to increase by 2008 the proportion
of those supported intensively to live at home to 34% of the total
of those being supported at home or in residential care'.
10.1.3. Reduce cost of care by reducing number of beds
occupied by older people both in acute hospitals and long-term
residential care facilities. Supporting DH objectives to "improve
health outcomes for people with long term conditions by offering
a personalised care plan for vulnerable people most at risk; and
to reduce emergency bed days by 5% by 2008 (from the expected
2003-04 baseline) through improved care in primary care and community
settings for people with long term conditions."
10.1.4. Improve management of care by identifying a deteriorating
condition before a crisis point is breached enabling treatment
to be refined and shaped through timely and accurate health information.
Further supporting DH objectives outlined in 1 and 2 above.
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