Agenda item

There is a national agreement that the Health and Social Care economies must work together to improve the outcomes for individuals who require additional support, whatever stage of life they are at.

Those providing help for people have, for some time, acknowledged that technology will play a larger part in providing that support. The Council and health partners are committed to delivering a local digital roadmap which is a key part of the Kent and Medway Health and Social Care Sustainability and Transformation Plan (STP). Technology enhanced care services form an important part of that.

This report begins to explore some of the options that are available now for technology enhanced care services and will be possible in the near future.

Discussion

The Head of Adults’ (25+) Partnership Commissioning and the Better Care Fund introduced the report. This provided an overview of current work, the activity that would soon commence and some of the longer term plans in relation to Technology Enabled Care Services (TECS).

TECS were an enabler within the Sustainable Transformation Plan. The services were currently being used by around 1,500 private patients, 1,000 of whom were supported through Adult Social Care, as well as a further 1,500 people in other types of accommodation. These services were supporting people to be cared for at home rather than in hospital, which was generally the preference of patients. Telecare enabled health and social care services to engage with people remotely through the provision of real time patient information. Patients were enabled stay in their home longer through the management of long term chronic conditions.

A trial was currently running in Medway, which used a smartphone and other equipment to enable a community nurse to log in and get real time patient information. This could be used to determine whether a visit was necessary, thereby giving the practitioner more time to visit patients who needed this the most. The system also enabled GPs to receive an electronic discharge notification when a patient was discharged from hospital.

There had also been some roll out of preventative services, such as a community Geriatrician initiative. This practitioner, based in a practice in Gillingham, had gone through all the records of frail and elderly people and called them in for an in-depth needs assessment at the surgery. Couples would be seen together. The geriatrician was able to access records, including details of hospital admissions. A further trial was due to take place in the New Year.

Medway NHS Clinical Commissioning Group had invested in software that enabled existing software systems to interact with each other and to facilitate the sharing of information between healthcare professionals working for different organisations.

The Committee raised a number of points and questions as follows:

Shared software systems and financial savings associated with telecare provision: In response to a Member who asked why shared information systems were only now being developed when other industries had used such systems for years and how it could be known whether savings would be made through the use of telecare when this had not been accurately tested in Medway, The Head of Adults’ (25+) Partnership Commissioning and the Better Care Fund advised that such systems had not been developed sooner due to information governance considerations. Health services had been provided on the basis that information would only be shared with other parties where patients had explicitly given their consent. The sharing of patient information was extremely sensitive, with there still being significant hurdles to overcome. The establishment of systems that could interact with each other and which share only the information that the patient had given permission to be shared would take time. In relation to savings, it was widely accepted that savings could be realised if remote contact with patients was increased and if systems could be linked together to reduce duplication. The Interim Assistant Director of Adult Care Services said that trials across the UK had shown that remote monitoring of patients enabled intervention to take place sooner. This would also reduce costs.

Telecare costs, patient care and data security: In response to a Member question about the cost of telecare, whether there was a risk that some patient problems would be missed and data security, The Head of Adults’ (25+) Partnership Commissioning and the Better Care Fund stated that a basic telecare package cost a private subscriber £6 per week. The Council was responsible for this provision, which was provided by Medway Commercial Group. Patients receiving telecare as part of a Home First care package had the cost paid by the Council for six weeks. If the patient opted to keep it after an initial six week period, they would generally then pay this cost themselves. Where telecare was provided as part of continuing healthcare, this would be paid on their behalf. A variety of additional options were available, therefore, the cost to the individual could be higher. A balance needed to be achieved between the risk of reducing contact with patients and there being an increased risk of something going wrong due to the number of people involved. The system being created would ensure that each professional involved in a person’s care had a complete picture of it. In relation to information security, the NHS had stringent information governance protocols. The security of a closed system had to be balanced with the need for timely information to be available to those delivering the care.

Risks associated with telecare: A Member expressed concern that there was the potential for there to be serious failings in care when this was being provided remotely and wanted reassurance that the associated risks were fully understood. Remote provision and reduced personal visits could also increase loneliness. She considered that telecare should be used where it best suited an individual’s particular set of circumstances and not just because it was cheaper than other types of care provision. The Member also questioned what sort of training and checks had been made of the frontline staff providing services. The report author advised that telecare was put in as an enabler, rather than as a substitute. It provided assurance that a vulnerable person was being monitored 24 hours a day. If often was the case that an individual would not require or want a carer to be with them constantly and remote monitoring could help to facilitate this. Medway Commercial Group worked alongside domiciliary care providers, educating them about the operation of telecare. Staff would have received appropriate training and background checks. The officer offered to find out precisely what checks were subject to.

Decision

The Committee noted and commented on the report provided.