Long-term Conditions and Telehealth in North Yorkshire & York

1. Long-term Conditions and Telehealth in North Yorkshire & York Kerry Wheeler, Assistant Director of Strategy – Programme Lead for Telehealth

2. The big picture - NYY • North Yorkshire has a population base of 794,532 • LTC affects a significant proportion of the total population; 176,000 people registered on QOF; 50,000 with Diabetes, COPD and Heart Failure • Patients with a LTC are more intensive users of healthcare services • NHS NYY estimates a 14% increase in the population by 2020, with more people living longer and an estimated 22% increase in those aged 65+ years / 50% over 85s. • Prevalence of LTC rises with age • Financial challenges in NHS

3. Why Telehealth? • An enabler to support implementation of LTC care pathways - fragmented • Emerging (inter)national evidence base • Non-elective admissions increasing by 5-10% a year against a background of reduction in financial allocation; expectation that care is provided in a different way • LTC - frequent cause of admissions to hospital. Example: COPD spend is circa £10 million with £3 million on primary diagnosis; • Rurality of NYY leads to issues regarding access to services and efficiency of service delivery • “Push” from NYCC – significant impact from telecare • Support from the SHA to act as a pioneering site for the region

4. How did we start the Project? April 09 - PBC Consortia approached NYY to implement Telehealth across 4 Localities (Whitby, Hambleton/Richmondshire, York & Selby) as part of phased approach within longer term programme. June 09 – 120 units, 2 Suppliers, establishment of project team, internal steering group and executive board Sept 09 - Commenced implementation through Community Staff. Early evaluation through YHEC showed positive impact Dec 09 – Procurement of 2,000 Telehealth units for full scale roll out across NYY April 10 – Commencement of 3-year contract with Tunstall Healthcare September 2010 – Phase 2 monitoring commenced

5. Which LTC are part of the Telehealth programme? 6,705 Heart Failure patients and 11,505 COPD patients in NYY, with an estimate of 1,000’s more undiagnosed. LTC with trackable vital signs indicative of health deterioration; e.g. COPD exacerbation / reduction in oxygen saturation levels, heart failure decompensation / increased weight through fluid accumulation Diabetes as a co-morbidity to COPD and Heart Failure

6. Progress over last 12 months...... Commenced work with Clinicians on redesign of care pathways for COPD, Heart Failure and Diabetes – July 2010 Telehealth within pathways as a clinical tool (enabler) Process about system change and selection of appropriate patients, not deployment of units Pathways completed & signed off by PBC and Commissioning Executive in October 2010 – NICE and Map of Medicine compliant Service specifications and KPIs included in contracts from April 2011 By Locality – savings plan based on implementation of pathways and deployment of telehealth Ongoing clinical engagement across all sectors

7. Progress over last 12 months...... Community Staff all trained and largest referrers – clinical advocates 47 out of 100 Practices visited to discuss Project. 85 Practices now with patients on telehealth units 7 Practices referring and directly managing Patients – 34 patients in total As at 20 June 346 “live” Patients on units, almost 500 referrals Monthly performance dashboard – as at end of May 2011, 54% reduction in non-elective activity (150 patients for 6+ months) Alert rate to clinicians – 3% Telehealth website – nyytelehealth.co.uk

8. Focus during 2011/12 Full deployment of units by March 2012 Key Projects: Deployment of 1,000+ units to COPD & Heart Failure Patients from York Trust Deployment of 100+ units from Haxby Group Practice (2nd largest Practice in NYY) Rapid deployment of T-Health Project within Scarborough Trust – 100+ units to Heart Failure Patients Support to Craven GPCC and Harrogate GPCC on delivery of QIPP plans Project reports through Central QIPP Board at PCT Work with LMC on QOF plus GMS/PMS incentives Work with the Nuffield on independent evaluation of the Project

9. What are the benefits of Telehealth? Alerts clinicians to priority patients / early warning of clinical deterioration Provides easily accessible, historical, and current trend data and health interview responses, to all clinicians involved in the patients care. Supports clinical decision making and monitoring during changes in the patients therapy Patients more in control and confident to manage their own condition leading to improved quality of life Potential to support Early Supported Discharge Schemes from acute hospitals

10. The common questions – clinical engagement • What is the evidence for telehealth? • What impact will this have on my workload? (3% crucial) • Will we get paid for the extra capacity required to do this – shift in workload? • How do I select the right Patients and set alert limits? • What are the costs for this? (either upfront or post PCT funding)

11. Commissioning Telehealth... Clinical engagement pre-procurement Dedicated management support to take Project forward Clear reporting/governance for Project to Board Identify clinical champions Good Comms/PR essential – mixed messages Telehealth – clinical tool to facilitate service change Prove not just another short term initiative Patience!