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National Telecare Development Programme (TDP)

Summary

Description

Operational Information

Evaluation

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Summary

The National Telecare Development Programme for Scotland was launched in August 2006 as a policy initiative to drive the adoption of telecare by local social and health care service providers. The initiative involves authorities at different levels (local, regional and national) and different social and health care services and professionals (General Practitioners, home care managers etc.) and offers tailored ICT-based support packages to carers and the people they care for, thus providing help and flexibility for both in terms of improved well-being and employment opportunities for the carer, and increased independence for the person who is cared for.

The TDP covers a range of ICT-based devices and services aimed at improving care in the following three main areas: independent living, personal support and social integration for carers and coordination between formal and informal care. The installation of equipment in users’ homes has been unproblematic in most cases, and carers receive instructions on how to use it by a professional. All carers felt that the equipment had been demonstrated well and a contact telephone for further assistance was provided for further support. The TDP has a positive impact at three levels: it helps private care organisations to save costs; it helps private companies to reduce absenteeism of working carers; and it helps the National Health System to prevent unneeded hospitalizations.

From 2007 onwards, over 43,000 people accessed a TDP service, with more than 30,000 still receiving one in March 2011. For the period of 2010/11, over 14,000 new clients received a telecare service, while almost 6,000 people stopped receiving it, thus showing a growth in telecare service provision of over 8,400 new users in this period.

This initiative receives private and public funding so that only a little co-payment is requested from citizens the amount of which depends upon the support provided by the local authority.

Description
refers to the target users, kind of service provided, ICTs typologies and devices used

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National Telecare Development Programme (TDP)
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Scotland
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01-08-2006
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01-03-2015
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To offer tailored ICT-based support packages to carers and to the people they care for; helping them and providing flexibility for both in terms of improved employment opportunities and ‘peace of mind’ for the carer, and increased independence for the cared-for person.

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The number of people aged 65 and over in Scotland is projected to rise dramatically in the future, from 1.02 million in 2008 to 1.07 million in 2018 (an increase of 6 per cent) and even more rapidly afterwards, reaching 1.34 million in 2033 (an increase of around 31 per cent compared to 2008) (GROS, 2009). This trend will result in a greater need for appropriate health and social care, with nearly two thirds of people over the age of 65 suffering from at least one limiting illness and over a quarter of people over 75 suffering from two or more. Providing care for this growing number of people is likely to become problematic, with a greater emphasis on care given by family, friends and neighbours.

To counter this trend, the Scottish government has developed a number of initiatives with the objective of tackling these increasing long term health and social care needs. One of its key policies is “Reshaping Care for Older People” and its associated Change Fund, which represent one the main actions carried out by the Joint Improvement Team (JIT). This is a Government organization that was established in 2004 to provide practical support and additional capacity to Scottish Health and Social Care partnerships. With a budget of approximately £70 million its remit is to plan, implement and deliver sustainable health and social care services and better outcomes for users.

Within this initiative, key issues for carers include the involvement of carers in service development, patient centred care, joint assessments of carers and their dependents, ‘joined up’ health and social care services, and the use of telecare in supporting clients and the care they provide/receive.

Telecare has been identified as playing an important role in new models of service delivery, with the following potential benefits:

  • enabling people to stay in their homes for longer
  • reducing the need for home care
  • delaying admissions to residential care
  • reducing the number of hospital admissions
  • reducing the number of delayed discharges from hospital.

As a consequence, telecare is also expected to lead to considerable cost savings in the care system. Additionally, through active lobbying by Carers Scotland, the role of carers has been explicitly built into the telecare development programme.

In the period from 2006-2011, the JIT supported the development of telecare services through an initiative called the Telecare Development Programme (TDP), investing over £20 million. in it Within the Scottish government’s key strategy “Seizing the Opportunity”, the role of telecare in meeting future challenges in the provision of health and social care was outlined, including the following aims:

  • Increase awareness of telecare and its benefits;
  • Increase the use of telecare in mainstream service provision;
  • Improve assessment procedures for service users;
  • Train service providers’ staff to incorporate telecare within care packages;
  • Ensure telecare services are delivered to recognised standards;
  • Enhance innovation in telecare services.

The TDP began in August 2006 and ended in March 2011. Of the £20.35 million invested, £2.75 million financed an innovation programme and met management costs, while the remainder was allocated to care partnerships, enabling service expansion. Each Scottish local partnership submitted a bid for funding its own telecare project based on a strategic plan. After allocation of funds, the JIT supported each local partnership to develop a telecare scheme with a focus on innovative approaches to cater for local needs.

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Yes Care Recipients
Yes Informal carers
Yes Paid assistants
No Formal carers

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Not available

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Yes Independent Living
No Information and learning for carers
Yes Personal Support and Social Integration for carer
Yes Care coordination

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Telecare Scotland provides services such as independent living to care recipients, as well as employment, leisure and relief opportunities and support to carers. Lastly, both informal and formal carers receive effective and prompt information on the cared for person’s health condition.

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Kind of technological supports used by carers and/or care recipients:

  • Monitors and motion sensors. The responses may range from a phone call to the person, to alert a local carer or neighbour or social service or emergency services if appropriate;
  • Water level monitor in a bath;
  • Fall detectors;
  • Smoke detectors;
  • Medication reminder equipment and services;
  • A pill dispenser programmed with dosage and times with an alarm that sounds to prompt the user to take their medication. If the medication has not been taken, then the dispenser reminds the user that a dose is due. An alert will be sounded if the medication is not accessed within the following hour.

Operational Information
refers to the type of funding, budget, sustainability and organisations involved

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Both public and private
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Public service funding: Government, Regional, Local Authorities, non-profit public entities
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Not available

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Private out of pocket: users pay the service by themselves
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Not available

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The service had a business plan expectation of about £1,800 in 2010.

Payment options for the users vary according to the local authority providing the support, with costs ranging from a nominal fee per week to being free of charge in certain areas. The fees are not regarded as unreasonable by users.

Each Scottish local partnership (Scottish Government, Convention of Scottish Local Authorities and National Health System Scotland) submitted a bid for funding for its own telecare project based on a strategic plan. After the allocation of funds, the JIT supported each local partnership to develop a telecare scheme with a focus on innovative approaches to cater for local needs.

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After the Telecare Development Programme ended, the service has continued to be sustained thanks to another public fund. The Scottish government is acting with the Technology Strategy Board, an organization that stimulates technology-enabled innovation in areas that are important to boost UK growth and productivity and which advises the government on how to accelerate the exploitation of new technologies. The government has announced a new telecare/telehealth initiative running in 2012-2015 called “Delivering Assistive Living Lifestyles at Scale” (DALLAS), with NHS24/Scottish Centre for Telehealth and Telecare commissioned to deliver the Scottish part of this UK-wide scheme. DALLAS is the first phase of a wider Scottish Assisted Living Programme, which aims to use new technologies to support people with health and social care needs in their own homes.

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€ More than 500,000
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€ More than 500,000
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Not available

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Yes Authorities
No Private Care Sector
Yes Health and Social Care Systems
No Third Sector
No Private Companies

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Not available

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There is no involvement of the third sector
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No Informal Carers
Yes Health Professionals
Yes Social Care Professionals
No Privately-Hired Care Assistants (inc. Migrant Care Workers)
No Volunteers

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The group includes GPs, health, housing and social care managers and practitioners, independent consultants experienced in working in social services, acute and primary health care.

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There is no involvement of the third sector.

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10,001 - 50,000
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43.000 users reached.

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Web-site, publications and workshops

Evaluation
refers to the impact of the service on end-users, care organisations and authorities

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The service impacts on:

a) Care recipients because it avoids unnecessary hospitalisations and gives support to live independently;

b) Informal carers because it improves their health and well-being and decreases their stress level (Beale et al, 2009), helps them to reconcile work and care, provides work opportunities and the opportunity to access new services (Jarrold and Yeandle, 2009).

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This service is beneficial to:

- Private organisations that provide care because it helps them to save costs and optimize resources;

- Companies and the labour market in general because it helps the informal carer reconcile paid work and caring tasks (Jarrold and Yeandle, 2009).

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The service provides benefits to the NHS and local social care services, because it helps to reduce the costs of home caring and hospitalisation (Newhaven Research, 2011).

Overall, the gross value of TDP-funded efficiencies over the period 2006-10 is approximately £48.4 million at current prices. The financial value of gross benefits achieved was fairly close to expectations given the uncertainties necessarily involved in business planning.

By 31st March 2010, approximately £10.4 million of TDP funding had been spent by local partnerships, and another £2.6 million as match funding. Around 1,500 hospital discharges were expedited as a result of TDP funding in the period 2006-10, against a business plan anticipation of about 1,800. At the same time, around 6,600 unplanned hospital admissions were avoided (compared to an expectation of around 3,800). Over 2,650 care home admissions were also avoided, against an initial projection of 3,025. By achieving the above outcomes, the partnerships saved around:

• 346,000 care home bed days (initial projection: 188,000);

• 65,000 hospital bed days through facilitated discharges and unplanned admissions avoided (projection: 80,000);

• 35,000 nights of sleepover/wakened night care (projection: 55,000);

• 411,000 home check visits (projection: 615,000).

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The following analysis is based on the studies carried out by by Jarrold and Yeandle (2009) and on the Newhaven Research (2011).

Strengths:

  1. The TDP has a positive impact on carers’ quality of life, because it offers them peace of mind’ about the well-being and safety of the person they cared for, improves the interaction with the old person they care for, it is an additional support to the home caring and helps them to reconcile work and care.
  2. Most local partnerships in Scotland are on the way to delivering telecare as a mainstream service, there are recognized and accepted standards for this service, and increasing awareness of the power of telecare to transform lives as well as working practices.
  3. Telecare Development Programme (TDP) funding accelerated the development of telecare in Scotland: over 43,000 people enjoyed a service during the period 2006-10.
  4. Some of the key elements of the strategy–targeted (non financial) support to individual partnerships, promotion of the standards agenda, and aspects of the innovation programme – have been achieved.
  5. The Newhaven Research (2011) reports the following efficacies of telecare:
  • the average number of hospital bed days saved per reduced delayed hospital discharge was 11;
  • the average number of hospital bed days saved per unplanned hospital admission avoided was 9;
  • the average number of care home bed days saved per care home admission avoided was 143.

Weaknesses:

Some important aspects have still to be clarified:

  1. carers’ knowledge about the types of telecare equipment available is still low;
  2. carers have access to a limited range of telecare equipment;
  3. carers feel faster referrals to telecare services and enhanced equipment would benefit carers of people with demanding conditions like dementia;
  4. The housing role in telecare service provision remains to be fully developed;

Opportunities:

  1. The possibility to count on additional funding for sustaining the mainstreaming of telecare in the future: a new telecare/telehealth initiative running from 2012-2015 called Delivering Assistive Living Lifestyles at Scale (DALLAS) (see “Sustainability” section).
  2. Telecare is much more widely understood and appreciated than it was.
  3. Some progress has been made on integrating health and care service working arrangements.

Threats:

  1. Ultimately the core telecare policy objective 2006-10 was, to ensure that telecare is mainstreamed in Scotland as a way of supporting a shift in the balance of care in a cost-effective manner. The evidence coming from the partnerships involved supports the conclusion that considerable but not complete progress has been made in this regard. While some partnerships are much further down the road than they were even a year ago, a number of partnerships have made the transition to a fully mainstreamed service, The removal of TDP funding, extended for 2010/11, will not lead to partnerships running telecare service provision down in the majority of cases: nearly 80% of partnerships say that local telecare services will not diminish once TDP funding is withdrawn. The TDP pump priming exercise therefore appears to have been successful.
  2. The evidence from a self assessment survey suggests that 22% of Scottish partnerships (or 7 partnerships in absolute terms) are now there or almost there in terms of mainstreaming. The bulk of partnerships (63%, or 20 partnerships in total) may be considered to be to a greater or lesser degree solidly on their way. This leaves some 15% (5 partnerships) over which there may still be said to be a serious question mark.
  3. An Action Plan has been developed by the national Telecare Programme Board which builds directly upon the 2008-10 Telecare Strategy. It provides continuing strategic direction and support for Local Partnerships and other key stakeholders in the development and implementation of their telecare programmes.
  4. Alongside this, a more coordinated approach to telehealth has been progressed, and this Action Plan has been specifically designed to be complementary and provide additional impetus to actions within the “Strategic Framework for Telehealth” published by the Scottish Centre for Telehealth/NHS 24 (NHS 24- Scottish Centre for Telehealth, April 2010).
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Considering the easy installation of the equipment and its reasonable cost, the initiative seems to be easily scalable at different levels.

More Information
includes contacts, publications and accompanying documents

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References:

Jarrold, K. & Yeandle, S. (2009). A Weight off my mind. Exploring the impact and potential benefits of telecare for unpaid carers in Scotland. Leeds: University of Leeds, http://www.sociology.leeds.ac.uk/circle/circle-projects/completed-projects/exploring-the-impact-and-potential-benefits-of-telecare-for-carers-in-scotland.php (last access: 10 June 2013).

Newhaven Research (2011). The Telecare Development Programme in Scotland 2006-11. Edinburgh: JIT, http://www.epractice.eu/files/The%20Telecare%20Development%20Programme%20in%20Scotland%202006-11.pdf (last access: 10 June 2013).

Publications:

Beale, S., Sanderson, D. & Kruger, K. (2009). Evaluation of the Telecare Development Programme: Final report. Edinburgh: The Scottish Government.

Boddy, M. & Henderson, D. (2009). Implementing Telecare: An action guide. Edinburgh: JIT, http://www.jitscotland.org.uk/toolkits/implementing-telecare-an-actionguide/ (last access: 10 June 2013).

Bowes, A. & McColgan, G. (2006). Smart technology and community care for older people: innovation in West Lothian, Scotland. Edinburgh: Age Concern Scotland, http://www.patientconnect.com.au/ws-content/uploads/August_2006_Patient_Connect_-_Telehealthcare_-_Pilot_Study_-_University_of_Stirling_Telehealthcare_Study.pdf (last access: 20 June 2013).

GROS (2009). Projected Population of Scotland (2008-based). General Register Office for Scotland, http://www.gro-scotland.gov.uk/files2/stats/projected-population-of-scotland-2008-based/projected-population-of-scotland-2008-based-publication/projected-population-of-scotland-2008-based.pdf (last access: 10 June 2013).

Henderson, D. (2010). Telehealthcare in Scotland: A strategy for education and training in 2010-12. Edinburgh: JIT, http://www.jitscotland.org.uk/downloads/1270121217-Education%20and%20Training%20Strategy.pdf (last access: 10 June 2013).

 

Joint Improvement Team (2007). Summary of Current and Developing Telecare Services in Scotland. Edinburgh: JIT.

Newhaven Research (2009). Monitoring Telecare Progress. Edinburgh: JIT, http://tiny.cc/1i8gx (last access: 10 June 2013).

 

Sergeant, E. (2010). Summary of Telecare Service in Scotland. Edinburgh: JIT, http://www.jitscotland.org.uk/downloads/1271156983-Summary%20Report%20Telecare%20March%202009.pdf (last access: 10 June 2013).

The Scottish Government (2010). An Assessment of the Development of Telecare in Scotland 2006-2010. Edinburgh, The Scottish Government, http://www.scotland.gov.uk/Resource/Doc/328586/0106225.pdf (last access: 10 June 2013).

NHS 24-Scottish Centre for Telehealth, Scottish Centre for Telehealth Strategic Framework, http://www.nhs24.com/AboutUs/NHS24Board/StrategicPlanning (last access: 10 June 2013

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Contact person:

Joint Improvement Team
Area 2ES
St Andrew's House
Regent Road
Edinburgh EH1 3DG

Tel: 00 44 0131 244 3535
Email: jit@scotland.gsi.gov.uk