New ways of working with New Technology Alan Bell Senior Manager Communities & Information

1. New ways of working with New Technology Alan Bell Senior Manager Communities & Information

2. West Lothian context – background information Around 170,000 residents, currently relatively young, but rising quickly in terms of older people Mix of urban and semi-rural population 10th largest local authority in Scotland 1400 staff in Social Policy Best Social Work Inspection Agency report in Scotland

3. West Lothian context - demographicsTable 1: Numbers of people over 60 projected for West Lothian 2005 - 2018 Age group 2005 2012 2018 Rate of increase 60 -69 15,164 18,260 19,205 27% 70 - 79 8,952 11,022 13,715 35% 80+ 4,287 5,292 6,756 58% Total 28,403 34,574 39,676 40% In 2006, there were 5.3 people of working age in West Lothian for every pensioner. In 2031, there will be 2.8 people of working age in West Lothian for every pensioner

4. Drivers • Demographic changes in service users and staffing groups • Resource constraints on traditional growth • Efficiency focus - same or similar services provided in different ways • Effectiveness focus - service user expectations/personalisation agenda

5. What were we trying to achieve • Better experience at the points of contact, assessment and service delivery • Maximising the meeting of needs with available resources • Equipping the staff with the best information and back-up possible • Making the end result for people as quick and as comprehensive as we can make it

6. How did we go about it? • Redesigning people services and processes • Backing that up by the use of technology where helpful • Supporting staff by equipment, systems and training • Communicating clearly with service users and their families/carers • Gaining staff commitment to improved ways of delivering services

7. Older People’s Services re-design • Replaced outdated care home provision with combination of Housing with Care units and modern care home provision • Demolished 4 Old People’s Homes, built 2 new care homes in partnership with NHS, 6 new Housing with Care units • Fitted 4000 households (serving 5100 people) in the community with assistive technology (Telecare) • Established in-house team capable of Telecare assessment, installation and response • Modernised Home Care Service (provider focused) into a Personal Care Service (client focused) • Simplified assessment processes using less qualified staff for basic assessments, introduced self-assessment for simple items • Focused on re-enablement, particularly for hospital discharge cases, leading to reduced packages of care in the medium term

8. Telecare equipment

9. Telecare system fundamentals • Home based equipment • Messages sent to collating software • Call centre decision making according to protocols pre-defined by professional • Response arrangements in line with protocols

10. Smart technology in homes Housing with Care Home Safety Service + Home Safety Service Lifestyle monitoring Assessment tool Telemedicine Medication Reminder Epilepsy Monitor Fall detector Chair/Bed Occupancy Detector Wandering Detector Incontinence Detector Automated Reminders Video door entry Carbon monoxide detector Voice recognition Home Alarm unit/two way speech Smoke Detector Extreme Temperature Sensor 2 x Flood Detectors 2 x Activity Detectors

11. Redesign Outcomes • Reduced numbers delayed in hospital discharge from 67 in April 2000 to 0 in April 2007 and maintained since • Reduced length of average stay in care homes from 36 months to less than 12 months • Reduced waiting times and lists for assessment and service delivery • Enhanced staff skills, roles and job satisfaction • Reduced packages of care for significant number of service users • Capped number of formal home care clients and care home places against 10% population growth 2003 - 2009

12. Annual cost comparison • At home with telecare £2845 • With 10 hrs care and telecare £8745 • Housing with care £16,640 • Nursing home £20,800 • Acute hospital bed £87,500

13. What have we learned so far? • Introducing assistive technology on its own without wider system improvements is a wasted opportunity • Assistive technology is not a cut-price alternative to personal service but helps stretch the human element further • An approach driven solely by technology won’t work • High level of commitment particularly at senior levels is required • Careful approach and investment of time in taking staff, users and carers is required

14. New ways of working with New Technology Alan Bell Senior Manager Communities & Information alan.bell@westlothian.gov.uk