Telecare and telehealth policy: an update on recent Government policy
As commissioners and providers across England develop their telecare and telehealth programmes, it is important to keep up to date with government policy updates in health, housing and social care. This article reflects on several key government publications in June/July 2009. The Department of Health has also published a recent document that provides an overview of the Whole System Demonstrator programme.
The social care Green Paper
Shaping the Future of Care Together sets out a vision for a new care and support system in England. The Green Paper highlights the challenges faced by the current system and the need for radical reform, to develop a National Care Service that is fair, simple and affordable for everyone. The Green Paper consultation runs until 13 November 2009.
The report considers targeted approaches to help people who are likely to need greater amounts of care and support. Telecare (p 51) is identified as one route that will improve the quality of life for people and make the system more efficient.
The report indicates that telecare can be particularly helpful in keeping people safe in their own homes, and giving them confidence. Using technology to enable delivery of high-quality support will be a vital element of the future care and support system.
‘We will continue to promote telecare so that people feel more confident about staying in their own homes for longer.’ (Department of Health, July 2009).
Part of this approach is to also ensure that everyone can easily obtain information about prevention and early intervention. This includes (p 56) information and advice on the services that are available and how to choose between them. The Green Paper stresses the need to build a robust evidence base for telecare.
Building a Society for all Ages
The government has published a report entitled Building a society for all ages that links with the social care Green Paper. There are references to the £80 million Preventative Technology Grant (p 13) as well as the aim (p 41) to make care more flexible for individuals and families by encouraging new technologies such as telehealth and telecare.
The Older People’s Prevention Package
The Social Care Green Paper (p 52) and Building Britain’s Future (Ch 6, Section 20) refer to the Older People’s Prevention Package. The Prevention Package raises the focus on prevention as a means of ensuring good health, well-being and independence in later life, by promoting and encouraging uptake of comprehensive health and social care services for older people. Announced in 2008, the health prevention package was launched on 22 July 2009. Among other initiatives, the prevention package seeks to summarise existing progress on telecare.
Working Together for Older People in Rural Areas
The Cabinet Office has published a report on Working Together for Older People in Rural Areas that includes telehealth references (p 27) and provides a case study of Cornwall and the Isles of Scilly as a rural whole system demonstrator (p 29).
High Quality Care for All
At the end of June 2009, the Department published a report entitled High Quality Care for All: Our Journey So Far, which examines the progress that has been made since High Quality Care for All was published a year ago. Across each dimension of quality – patient experience, patient safety and clinical effectiveness – Lord Darzi has found that there has been real progress, with patients already seeing the difference. The report (p 31) makes reference to the Whole System Demonstrator programme and the value of telehealth and telecare.
Revision of the Fair Access to Care Services guidance
This paper is a consultation carried out by the Department of Health on the revision of the statutory guidance providing local authorities with a framework to determine individual eligibility for social care – the ‘Fair Access to Care Services’ guidance.
The draft revised guidance aims to reset the eligibility criteria framework within the policy context of personalisation and prevention set out in the cross-sector agreement for the transformation of adult social care – Putting People First.
The paper (p 12) considers that there should be targeted interventions to support individuals at risk. As part of this approach, it suggests that councils may wish to consider commissioning for assistive technologies, designed to help people with long-term conditions or support needs to maintain their independence and to reduce unnecessary use of hospitals and care homes.
The paper refers to an evaluation of the Telecare Development Programme commissioned by the Scottish government, which suggests that telecare can provide opportunities to promote independence and improve the quality of life of service users and carers, particularly for older people and those with dementia. The document also refers to the involvement of the Nuffield Trust in the multidisciplinary evaluation of the impact of telecare and telehealth on the use of NHS and social services, and the associated costs.
You can read more about the evaluation of the Scottish Telecare Development Programme in a WSDAN feature article written by the evaluation team from the York Health Economics Consortium.
Transforming Community Services: Ambition, Action, Achievement
At the end of June 2009, new guidance was launched by Lord Darzi to support the NHS in delivering the highest quality health care services within the community. The Transformational Guides for Community Services focus on six key areas: health, well-being and reducing inequalities; acute care closer to home; people with long-term conditions; rehabilitation services; services for children, young people and families; and end-of-life care.
The guides are also intended to help commissioners understand community services better and to help managers to identify areas where improvements can be made. They contain best-practice examples, which the Department of Health says has been shown to improve patients' experience of community health care.
The guide on transforming services for acute care closer to home (p 19) refers to using technology such as telehealth to help empower patients to monitor their own condition. This will enable patients to remain at home. The guide on Transforming services for people with long term conditions summarises high-impact changes (p 14) that would benefit patients as follows:
use a proven tool like the combined predictive model (PARR+) to risk stratify your local population
support and enable people to take appropriate and effective self-directed care and greater responsibility for managing their own health
use case managers as key workers to work proactively with very high intensity users (VHIUs) and those with complex care needs; develop shared care plans with realistic goal setting
invest in telehealth and telecare to empower patients to take control of their health needs, under the guidance and support of the case manager
develop personalised care plans using joint care planning/integrated assessment and join up multidisciplinary working along the care pathway.
In addition, the guide (p 18) advocates using technology (eg, telehealth/remote monitoring), to help people monitor their own condition to enable independence and, where practical, to avoid inappropriate admissions to an acute trust. Further references (p 21) cover transmitting data and clinical indicators such as blood pressure to clinicians using telemonitoring, computers or telephones. The guide considers that this can empower service users to monitor their readings and enable distance checking by professionals.
Mike Clark is co-project lead for WSDAN