Features: September 4th, 2009

By Neil Revely

The number of older people is rising steadily and so is the cost of caring for them. Pioneering councils are now using TeleCare to meet the challenge. The technology allows people to stay in their own homes giving independence and enhancing dignity. It also brings down the costs. The author describes how Sunderland City Council has adopted telecare to meet the needs of its growing elderly population.

There’s long been an arbitrary dividing line between health and social care, an unnecessary blurring of boundaries, funding and responsibilities which sadly has led to gaps in care for some of the most vulnerable members of society – namely older people and those with long-term needs. Sunderland’s vision is one of an all-age, all-ability city, where everyone has the choice to remain living independently and with dignity and respect and to retain control of their lives.

Our firm belief is that prevention is key to realising this vision. We are one of only two councils in England to provide health and social care to people across all four Fair Access to Care Services (FACS) bands, and in doing so we are succeeding in addressing healthcare inequalities and issues of deprivation, in keeping people safe and well in their own homes, and in ensuring best possible use of available resources.

Leading by example: Sunderland and the national picture

The UK Government is making committed steps towards more person-centred and flexible care delivery. Its Our Health Our Care Our Say white paper and Putting People First agenda both place a clear emphasis on longer-term planning, on providing more preventative community-based care that is delivered at a local level and tailored to meet the specific health and social care needs of the individual.

Government initiatives such as the £80m Preventative Technologies Grant and the Extra Care Housing Fund have been introduced to initiate a change in the design and delivery of health, social care and housing services. The most recent Government funding will also pay for costs incurred to help people with learning disabilities move from NHS accommodation and into housing in the community where they will receive the support they need to live independently and make decisions for themselves.

Telecare is as much about the philosophy of dignity and independence as it is about equipment and services. Sunderland’s forward-looking vision of health and social care delivery reflects the national drive for more preventative, community-based care, and for us it has telehealthcare firmly at its core.

Telecare at the heart of Sunderland

We have a passion for delivering non-institutional models of care. Telecare forms part of Sunderland’s vision of a virtual care village across the city, and plays a central role in our preventative healthcare model. Working with telehealthcare specialist Tunstall, we have now extended the service to 23,000 people across the city to date. Our sustained, preventative approach is working extremely well supporting individual choice and independence and helping people to remain safe and secure in their homes.

Providing telehealthcare across all four FACS bands helps us to measure risk and to provide appropriate health and social care services. As a result, we are also able to prevent or delay the need for more costly hospital intervention, thereby ensuring the most effective use of healthcare resources.

Telecare is not only unobtrusive, it also delivers round-the-clock support for service users, to ensure timely and preventative care when needed. Sunderland’s telecare service is backed up by the monitoring centre, a team of telecare technical assistants and the social and healthcare teams are available 24 hours a day. We provide a rapid response across the city, and can respond anywhere in the city within 15 minutes. This enables vulnerable people to stay safe at home, and helps prevent unnecessary admission to hospital or long term institutional care, as well as reducing the burden on the emergency services, who are receiving far fewer calls as a result.

Telecare has also been introduced to those with no assessed need for a cost of £3.20 a week, providing them with safety and security, and helping them deal with potential situations such as bogus callers.

We also mustn’t underestimate the impact of telecare on informal carers. When I asked my local Carers’ Centre what was the one thing carers who attended the carers centre couldn’t do without, two years ago they said the carers centre. Now it’s telecare they can’t do without.

Taking the next steps

We are looking to develop this model further through the use of telehealthcare hubs located at extra care sheltered housing, to reduce response times further and provide a truly world-class service for residents.

As part of this process, we also recognised that the training of care staff at the monitoring centre and hubs was fundamental to the modernisation of the service. With this in mind we have jointly developed a training programme in social and health care NVQ Level 3 with the Primary Care Trust (PCT), to ensure staff continue to provide a high level of care and support. By April 2008 we had trained 220 members of staff, a team of telecare technical assistants to help with fitting of equipment, provide advice, and support existing plans.

Reducing the bottom line and increasing social and health care outcomes: win-win for Sunderland

Resources need to be deployed cost-effectively and we have focussed on spending the right money, in the right way, in order to optimise outcomes across the community. For us, that meant a preventative approach with telecare at the core, and all of this has been achieved despite Sunderland having the lowest council tax rate in the North-East of England.

The benefits of telecare have been felt across the council and also the PCT – it supports the work done by community dementia teams, overnight services as well our health and social care professionals. It has also reduced the burden on the ambulance and A&E services, as the telecare monitoring and responder service helps reduce the number of avoidable admissions, by providing community care at an early stage.

In the last three years Sunderland has seen a drop in the number of people admitted to residential care from 110 per 10,000 to less than 80 per 10,000 and as the cost of residential care is the biggest and most expensive expenditure faced, this has realised significant cost savings.

The cost savings have been reinvested into additional preventative models of care creating a virtuous circle which is continuing to improve healthcare outcomes and make best possible use of resources. Investing in more frontline prevention puts us into a position to meet tomorrow’s health and social care challenges head on.

Laying the foundations for future health and social care provision

Over the next 15 years, the number of older people in Sunderland over 65 will rise by 30% to 59,500 and the number of older people with functional dependencies will rise from 22,400 to 27,000, including 4,100 people with dementia.

With an increasingly ageing population comes an increasing demand on health and social care resources, and our preventative approach means that we are well-placed to cope with future challenges.

Sunderland’s 15-year plan for Adult Social Care has a number of key aims which include extending the use of telecare to support people at home and plan holistically for housing and support needs.

Mainstreaming telecare on such a large scale and investing in the necessary technology and frontline support has required faith, evidence and commitment from all involved.

It’s about offering a holistic service. By choosing to adopt a preventative model of care across all four FACS bands, we have succeeded in improving healthcare outcomes for our residents, enabling them to live fuller, more independent lives. As a result of this, we are continuing to work closely with Tunstall to roll out telehealthcare on a wider scale to people with learning disabilities and people with chronic conditions, such as COPD and heart failure, in order to meet our vision of an all-age, all-ability city and world-class health and social care across the board.

Neil Revely is director of health, housing and adult services at Sunderland City Council.