Memorandum by Tunstall Group Ltd (MT 32)
SUMMARY
1. Simple technology, well made and configured
to produce effective outcomes, is with us now, and increasing
evidence confirms the benefits of the use of such technology primarily
to patients but importantly to both health and social care agencies.
The technology is cost effective relative to residential care
and hospital admission.
About Tunstall Group
2. Tunstall is Europe's leading supplier
of telecare products and services for older, disabled and other
vulnerable people. Established in 1957 and based in Yorkshire,
the company has sales of circa £70 million per annum, employs
around 750 people and operates in Europe, North America and Australasia.
It works with 90% of local authorities in the UK and spends some
5% of revenue on R&D.
The utilisation of telemedicine (including telecare)
and its future potential for improving services
3. Hospitals are great places for people
who need to be there, but are dangerous and often unhappy places
for people who no longer need acute levels of care. Properly supervised,
many people can receive rehabilitative care (or indeed often preventative
care) away from locations where the specialist facilities are
provided. By managing and monitoring risk many people can receive
services in their own homes or in community based nursing homes,
with costs now demonstrably much lower than the cost of a place
in an acute sector hospital. Shorter stays in hospital, or avoidance
of admission altogether, can mean that waiting lists can be reduced
and as has happened in at least one instance numbers of acute
sector beds reduced.
4. Key features of the sorts of technology
now being used in various parts of the country and the world are:
— They are simple, so have very high
levels of reliability at relatively low cost.
— They can be installed quickly without
the need for expensive hard wiring, so that decisions to discharge
can be implemented quickly.
— The infrastructure to manage the
provision of services already exists in the UK so "on costs"
are lower.
— Units can be supplied in flexible
configurations so that they reflect the needs of the patient.
— Risk can be managed, with individual
parameters set to reflect the health of each individual patient.
— Records can be maintained electronically
both in terms of the well-being of the patient but also when a
service is provided and who provides it.
The recommendations of the Healthcare Industries
Task Force (HITF) Report, published 17 November 2004
5. We welcome the publication of the above
report which states that "the case for an alternative model
which focuses on early diagnosis and prevention is gaining momentum".
Furthermore "remote monitoring technologies will allow the
health of at-risk patients to be monitored as they go about their
daily lives and treatment to be provided when there is an indication
of need emerging. All of this will be done via intelligent systems
which analyse streams of data, looking for patterns which indicate
if intervention is required."
6. The report also highlights the role of
assistive technology in the integration of health and social care.
"DH recognises that increasingly it is beneficial for patients
and service users to receive health and social care services in
the community where appropriate. For instance, in the management
of chronic disease and to support older people, which is a growing
need as the age profile of the population lengthens, solutions
often need to be implemented in the community or home environment
to meet people's expectations and enable them to live as normal
a life as possible, maintaining their independence. Increasing
emphasis on home care has meant closer co-operation between health
and social care and an expansion of resources in this area. By
2006 a further 100,000 people each year will be supported to live
independently at home. Whilst there are a number of issues to
resolve in delivering integrated services, caring for people close
to their home environment is a pressing objective for the future."
The availability of telecare is therefore consistent with the
recommendations of the HITF report and can help deliver the desired
outcomes
The speed of, and barriers to, the introduction
of new technologies
7. The announcements made by the Chancellor
last July in respect of additional funding are very welcome, and
will hopefully lead to an extension of the use of technology in
this way in other parts of the country. However, unless there
is good joint working between the NHS acute sector, primary health
care, social services and in many instances the local housing
authority, progress will be limited. All too often the fact that
it is the patient who primarily benefits is lost sight of as the
various agencies argue about finance. Shorter waiting lists will
benefit primary care services and social services. Reductions
in pressure for acute sector places will financially benefit primary
care trusts. Housing providers who often already have the basic
infrastructure in place can make their services more cost effective,
and workforce pressures can be reduced both in the primary care
sector and social services.
8. As the new money contained in the Comprehensive
Spending Review could point to a new model for funding care, direction
will be needed from central government to social services to avoid
diversion of funds into other local authority spending priorities.
There will be a need for policing to ensure that all the money
intended for telecare does indeed reach the front line.
9. In the feedback the company receives
from those individuals who now receive services based on our technology
not only do recipients of the service feel more confident that
their health and well being is being constantly monitored, but
relatives and carers also feel reassured that if the patient does
experience a deterioration in the health it will be identified
quickly so that appropriate medical interventions can take place.
10. As our technology develops the range
of conditions where it can be used is increasing. Many cardiac
conditions can be managed without the need for regular visits
to the doctor or outpatients department. This is particularly
effective in rural areas, as has been demonstrated in the monitoring
of women who are having complicated pregnancies in the Outer Isles,
where expensive trips to specialist clinics in Glasgow have been
reduced.
11. There remains a need to remind policy
makers at regional and local levels of the benefits of the use
of telehealthcare and telecare, with clearer direction centrally.
We remain convinced that if all the agencies work together money
becomes a non issue as the benefits to all become obvious.
12. We wish to emphasise also the need for
systematic deployment of telecare against national standards with
for example a single national care assessment and a model for
delivering telecare as needed, on the same day as the assessment
if possible. There is potentially a big role here for the NHS
Care Record System (NCRS) combined with a desktop telecare application
system.
The effectiveness and cost benefit of new technologies
13. Telecare technology is cost effective
relative to other forms of care. A basic system costs in the order
of £200 to £400, less than the cost of one week in a
residential care home (typically £450) and one day in an
acute hospital bed (typically £600). A fuller system for
more complex needs costs in the order of £500 to £800,
less than two weeks in residential care or two days in an acute
setting.
14. Telecare technology was endorsed in
the Audit Commission report of February 2004, which concluded
that there was sufficient evidence to recommend mainstream deployment
of telecare. The Audit Commission stated "the potential of
AT to promote independence and save money across public services
is not in doubt." According to the Commission there were
648,000 A&E attendances and 204,000 admission to hospital
for fall related injuries in people aged 60+ in 1999. Falls cost
the Government £981 million of which the NHS incurred 59%.
They also suggest that by utilising telecare the NHS could save
£63 million for COPD and £118 million in CHF alone (1).
15. This strong endorsement is supported
by the increasing body of evidence emerging from more than 20
telecare pilot projects across the UK.
West Lothian
16. One of the most well established is
in West Lothian in Scotland, which is being independently evaluated
by the University of Stirling. The results to date have shown
that there are real cost benefits both to the NHS and the local
authority, whilst rates of recovery have not been jeopardised,
but rather have improved.
17. The objectives of the West Lothian project
are to:
— provide a rapid response service
which aims to prevent hospital admissions and reduce the length
of stay;
— offer a home safety service to support
people in their own home for as long as possible;
— provide a housing with care model
to replace institutional care, which sustains independent living
through housing design, individually tailored care services and
the efficient use of new technologies.
18. The results for the first phase of the
project are as follows:
— the number of hospital bed days saved
was 3,364 (full year equivalent) with the service getting people
home quicker or preventing admissions in the first place;
— the level of delayed discharges for
people over 65 in West Lothian was reduced by around one third
to 2.14 per 1,000 people, compared to 4.33 in the rest of the
Lothian area;
— the length of stay in nursing homes
in West Lothian has dropped from approximately three years in
1999 to 1.8 years by the end of 2002.
Carlisle
19 In Carlisle patterns of healthcare delivery
have been changed through the use of telecare. The project aims
to develop and provide a range of community based services that
prevent avoidable acute admissions and facilitate the transition
from hospital to home and support continued independent living
at home, utilising modern telecare technology.
20. Since the scheme was introduced in February
2002, 420 individuals have received care packages in 13 months.
Most packages (60%) were put in place to support a transfer of
care, with 20% of packages instigated to monitor clients at risk
of falling, and 20% actually preventing admission to hospital.
21. An important aim of the project is to
release hospital beds and the major resources benefit of the project
is derived from the savings produced by this one aspect of the
project. The comparison of £5,100 for six weeks in hospital
(based on a minimum cost of £850 per week for a hospital
bed) and £154.28 for the care package cost speaks for itself.
22. The project has achieved its aims of
delivering an effective intermediate care programme through partnership
working, and fulfilling many of the standards set out in the NSF.
The project has demonstrated that telecare plays a key role in
delivering effective, client centred services, at the same time
releasing funds to be used for other vital services. The technology
sustains independence and promotes healthy ageing in a safe, home
environment, in line with both Government policy and the wishes
of the vulnerable.
Northamptonshire
23. The project explores the use of telecare
technology in the homes of people with dementia in Northampton,
with the aim of preventing admission into hospital or residential
care, supporting carers, promoting independence and reducing perceived
and actual risks. Assistive technology is installed following
a careful assessment of need. The project is currently actively
exploring ways of achieving a transition from project to service
by mainstreaming its practice.
24. The objectives are;
— To assess if assistive technology
can help people with dementia to remain living in their own homes.
— To delay or prevent the need for
them to enter residential care.
25. Results
— The costs of residential and hospital
provision amongst a comparator group over the 15 month evaluation
period were £66-68,000 higher (based on 14 service users).
— Telecare technology was a contributing
factor in enabling individuals to maintain existing levels of
independence.
Fold Housing, Northern Ireland
26. The Going Home Staying Home Project
is a partnership between Fold Housing, Foyle Health and Social
Services Trust and Northern Ireland Housing Executive. The three-year
project ends in April 2005 and generated funding from the Northern
Ireland New Directions funding programme.
27. The aim of the project is to offer support
to older people in the Foyle Trust area by supplying a range of
telecare and assistive technology, monitoring and support services.
The results to date show that:
— 320 people have received telecare
packages in the Foyle Trust Area.
— 356 people have successfully returned
home after leaving hospital with the most appropriate care package,
having spent six weeks in intermediate care.
— 15 people have received monitoring
for Chronic Obstructive Pulmonary Disease at home which has enabled
them to return home seven to 10 days earlier.
28. A study by Professor Mark Hawley (2)
has shown that deployment of Lifestyle Monitoring would have a
major impact on health and social care costs. A cost model has
been developed for a city such as Birmingham with 11,000 users.
Based on reduced hospital bed days, delayed entry to residential
care etc, at the end of 10 years, £8.3 million would be saved,
47% by the NHS, 49% by social services.
RECOMMENDATION
29. Central Government should issue strong
direction to social services departments to ensure that the new
money (Preventative Technology Grant) allocated in the 2004 Comprehensive
Spending Review should be spent as intended and not diverted by
local authorities into other priorities.
ORAL EVIDENCE
30. We would be delighted to give oral evidence
to the Health Committee if required
REFERENCES
1 Audit Commission (2004), Assistive Technology—Independence
and Well-being. ISBN 1-86240-464-X
2 Hawley M S (2003) Implications for Health
and Social Care, in Brownsell S and Bradley D, Assistive Technology
and Telecare, Policy Press. ISBN 1-86134-462-7.
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