Assistive Technology Project – CSED

1. Assistive Technology Project – CSED Telecare Advisory Network 11th September 2008

2. CSED Background • CSED established in 2004 by DH to assist Councils to achieve “Gershon” 3% efficiencies • Team of independent consultants and advisors • Portfolio of practical, evidence-based savings and improvement opportunities • Support with diagnosis and implementation of opportunities – free to CSSR’s; ownership of delivery rests with the councils themselves • Collaborative programme, working with local authorities • Skills transfer and building capacity in councils including business case development and benefits realisation • No powers to enforce; recognised as a critical friend to local authority • New delivery model from 2009

3. Challenges for CSSR’s in CSR 07 Period • The context in which the DH Efficiency Programme will operate during CSR 07 is the most fundamental reform of Adult Social Services in a generation. • The task facing the sector is to innovate and improve outcomes for a growing number of people, whilst achieving at least 3% efficiency savings • Transformation without efficiency is not sustainable • Efficiency without transformation will not release the figures required in the settlement

4. Reablement Commissioning and Brokerage Transforming Community Equipment and Wheelchair Service Models of Support Framework Crisis Response Support Related Housing and Technology Electronic Monitoring BPR Improving Web Access TRACS Planning Information Personalisation CSED Programmesand Initiatives

5. Rethinking the Approach: Managing for Independence – a New Framework for Models of Support – Prevention and “Upstreaming” (Low Level) Preventative Services Services that reduce the probability of a trigger event Trigger Event Occurrence that changes an individual’s circumstances and prompts an intervention Response to Trigger Event Actions to improve support pathway and avoid unnecessary actions and cost escalation • At Home • Day Services • Institutional Time-limited Intervention (Short – term) Reablement Focus Presumption of Cessation and Prevention • At Home • Day Services • Institutional Extended Intervention (medium / long–term) Reablement Focus 5

6. General Population “Low Level” Advice & Support Support At Home Institutional Care Acute Care People choose less dependent options:This is typically more cost effective TRANSFORMING SOCIAL CARE Transformation through Information (ACM) Internal Processes Crisis Response Re-ablement TCEWS Support Related Housing & Technology SYSTEM OPTIMISATION PROGRAMMES Commissioning and Brokerage Transforming Social Care Models of Support Planning

7. Assistive Technology Project Development Partners • A small number of councils whose evaluations of the use of AT indicated or claimed cost efficiencies • Developed or plan to develop a business case to integrate and mainstream AT this financial year: • Barnsley Metropolitan Borough Council, Bristol City Council, Cheshire County Council, London Borough of Havering, Staffordshire County Council, Stockton Borough Council

8. Assistive Technology Project The Issues • Assessment processes can misrepresent and limit understanding of individual need • A limited range of prescribed service solutions constrain the effectiveness and efficiency of support planning • Traditional solutions can be expensive, inflexible and limit independent living • Historically, service reviews are at best annual snapshots or triggered by a crisis. This is inherently inaccurate, ineffective and inefficient

9. Assistive Technology Project The Solutions Help councils integrate Assistive Technology into care and support services. Case studies and guidance on business case development show how to: • Improve the quality of assessments, challenge assumptions and reduce inaccuracies • Open up new options for individuals seeking independent living • Introduce more cost effective solutions than traditional options e.g. replace night staff with mobile response • Allow more efficient monitoring and management of risk

10. Assistive Technology Project The Benefits • Cashable efficiencies across the wider health and social care system arising from: • Better targeted timing and sizing of care packages and support • Greater choice of care options • Reduction in residential placements • Crisis-avoidance meaning fewer A & E and hospital admissions • Improved independence, choice and control for all client groups

11. AT in Integrated Care and Support Pathway Planning (Dementia) Early/Mild Mid/Moderate Late/Severe Ideal Solution Balancing Factors Tipping Factors Characteristics Characteristics Characteristics 1. 1. 1. L3 2. 2. L1 L2 L4 2. 3. 3. 3.

12. AT in Integrated Care and Support Pathway Planning (Dementia) The 4 levels represent different steps of increasing intensity of service For each transition e.g.L1-L2, L2-L3 , L2orL3- L4 there are factors that trigger a higher level of service (Tipping Factors) There are factors that might counteract the “Tipping Factors” (Balancing Factors) What are the ideal services that are necessary to delay “Tipping” i.e. Deliver the balancing factors?

13. TIPPING FACTORS L2/3 –L4 1 PROBLEMS OF INCONTINENCE 2 PROBLEMS OF NIGHTWAKING CHALLENGES 3 PROBLEMS OF AGGRESSION 4 CARER “ON DUTY” 24/7 5 LIMITED “CRISIS RESPONSE” SERVICES 6 DAY SERVICES NOT ABLE TO COPE WITH PERSON 7 NO “STEP-UP” DAY SERVICES 8 INADEQUATE “NAVIGATION” SUPPORT/CASE MGT

14. BALANCING FACTORS L2/3- L4 1 2 3 4 5 6 7 8

15. IDEAL SOLUTIONS L1/2 1 ASSISTIVE TECHNOLOGY 2 3 4 5 6 7 8

16. IDEAL SOLUTIONS L2/3 1 CENTRAL POINT OF INFORMATION AND SUPPORT, inc INFORMATION PORTAL 2 DEMENTIA REGISTER 3 4 5 ASSISTIVE TECHNOLOGY 6 7 8

17. IDEAL SOLUTIONS L3/4 1 CENTRAL POINT OF INFORMATION AND SUPPORT, inc INFORMATION PORTAL 2 DEMENTIA REGISTER 3 24hr ADVICE LINE 4 IMPROVED DEMENTIA CARE IN CARE HOMES 5 ASSISTIVE TECHNOLOGY 6 7 8

18. Agree critical elements of a high-level care pathway OK Need mod help Need intense help In institutional care Need some help I N C R I S I S Early diagnosis and emotional/planning support Case management (health and social care) Comprehensive care package Awareness raising Carer support Help with practical difficulties Health monitoring Preventive services, Self-help groups Stimulating, safe environment End of life care Avoid hospital admission Provide intensive help at discharge to maintain independence Training for all involved with older people – to detect early signs of dementia and signpost for assessment - to be able to manage service users with dementia

19. Redesigning the pathway Compare “As Is” dementia pathway with the ideal Consider existing services that could be decommissioned Consider what existing services could be reshaped Consider what new services could be commissioned Include Assistive Technology in redesign

20. Assistive Technology Project – Summary • A 6 month small scale project to explore role of AT in relation to ‘trigger’ events acting as a ‘balancing’ factor to provide ‘solutions’ • Objective • to prevent or delay individuals moving up the escalator of dependency • to support re-ablement and a return to community living and improved lifestyles within an independent living (choice and control) framework • Limited number of case studies demonstrate effectiveness of AT in assessment and the monitoring of risk whilst evidencing cost efficiencies • Implementation stage will publish case studies and support business case development focussing on tactical investment to support new models of support