review and highlight report 2015-2018 - digi health care€¦ · the content draws on a...

Review and Highlight Report

2015-2018

Towards a Digital Future

b Technology Enabled Care Programme

ContentsForeword 2

At a Glance 3

The TEC Landscape 2015 – 2018 4Telecare Feasibility 6Anticipating Future Demand 6Approach to Evaluation 6

TEC and the Health & Social Care Delivery Plan 7

TEC Highlights 91. Home and Mobile Health Monitoring 92. Video enabled services 143. Telecare 184. Digital Services and Platforms 245. Improvement and Support 28

Enabling Progress 38

What didn’t work so well 41

Embedding and Sustaining TEC 43

Gearing up for Digital Health and Care 45

Future national support 47Funding 47Webinars, learning events, peer support and networking 47Linking it all up 47Support for analysis and use of data and design of evaluation studies 48

List of Publications and Resources Referenced 50

2 Technology Enabled Care Programme

Now in our fourth year, the TEC Programme has continued to drive change and improvement in digital health and social care. This important national programme has significantly increased citizens choice and control to better manage their health and well being, and support independent living and has enabled over 84,000 citizens in Scotland to benefit from using familiar technology to improve their health, wellbeing and care outcomes.

Technology is already transforming the way we live our lives – at home, in how we interact socially, and at work. Technology offers massive potential to realise our ambitions to shift the focus of our health and care systems from crisis intervention towards prevention, enablement and supported self management.

The Digital Health and Care Strategy for Scotland recognises the contribution of TEC to date and sets out an ambitious set of priorities. The evidence form the TEC Programme is informing this work and will be further developed as a key element of service transformation to facilitate scale up and adoption going forward.

The question is no longer about proving the value and potential of technology enabled care – rather it is about understanding how to achieve widespread adoption so that TEC and digital are the default and ‘business as usual’.

Our report reflects on the progress that has been made towards this position and considers the key achievements, success factors, challenges, the learning to date, and priorities for future support. The content draws on a comprehensive review of TEC Programme reports, including the programme guidance, outputs from learning events and workshops, monitoring data, and the end of phase 1 reports submitted by all TEC locally funded partners.

A sample of case studies illustrate the benefits that are being achieved for citizens and for the health and care system in Scotland and the highlights of the TEC Programme are illustrated in the following Infographic.

We are delighted in what has been achieved to date through the programme and look forward to supporting the delivery of the Digital Health and Care Strategy and Health and Care Delivery Plan going forward.

Foreword We are pleased to share our Technology Enabled Care Review Report covering the key highlights for the Programme over the period April 2015 to September 2018.

Margaret WhoriskeyHead of Technology Enabled Care and Digital Health innovation

John BurnsChair, Technology Enabled Care Board

43 TEC funded partners

£25M investment

2 new national datasets developed for Telecare

and HMHM

Home & Mobile Health Monitoring:

17,708

Telecare:

39,268

4 4 Holyrood Digital

Health Awards:

Lanarkshire, Western Isles and NHS24

for both cCBT and Home and Mobile Health Monitoring

1 Scottish Public

Service Award – Attend Anywhere

Project Team

84,326 additional citizens benefited from TEC

52 learning events

Digital Platforms:

22,558

5 TEC work streams

VC and Attend Anywhere:

4,792

4 Star Reference Site Award

from European Commission

Review and Highlight Report 2015-2018 3

At a Glance


Whilst the ambition, complexity and scale of the TEC Programme is undoubtedly challenging, particularly as opportunities are continuously emerging and expanding, a key strength has been the agile, interdisciplinary and collaborative programme architecture. A cross sector TEC Programme Board provides strategic direction, rigorous governance and oversight of all activity funded through the Programme. The national programme team brings together people with expertise in policy, strategy, health, social care, housing, third sector, education, e-health, Telecare, Telehealth, programme management and improvement. The team members engage with local partners and provide expert advice and support on commissioning, procurement, adoption and evaluation of TEC.

The Programme aims to scale tried and tested TEC solutions in four work streams, each supported by improvement capacity to expand:

• Home and Mobile Health Monitoring (HMHM);• Video Conferencing (VC) and Video Enabled

Services;• Digital Services, including a national

framework for Digital Platforms;• Telecare, including a shift from Analogue to

Digital Telecare.

As TEC funding was initially available for one year, organisations were asked to complete a readiness self-assessment checklist to prepare to make effective use of this additional investment against at least one of the TEC work streams. Reflection on the scalability and anticipated benefits of their investment from the outset helped to deliver an early impact.

The TEC Landscape 2015 – 2018In late 2014, the Scottish Government announced additional investment and a new national programme to accelerate progress in technology enabled care to significantly increase citizen choice and control in health, well-being and care services. This was set in the context of the health and wellbeing outcomes for integrated care and to build on the progress achieved in implementing the National Telehealth and Telecare Delivery Plan.

Home and Mobile Health

Monitoring

Improvement and Support

Expansion of Telecare

Inc. Analogue & Digital

Video Conferencing

Digital Platforms

Fig 1 TEC Programme Work streams


In Year 1, around 25,000 additional people benefited from Technology Enabled Care.

A more incremental and co-design approach was used to allocate funding over years 2 and 3, enabling applicants to fully develop their proposals with the national team. Applicants were expected to demonstrate a commitment to the following key objectives:

the Vision in the national action plan for TEC published in August 2016.

OUR VISION:

“Scotland is an international leader in technology enabled care, supporting more people to live longer healthier lives at home or in community settings.”

The 2016 action plan, Supporting & Empowering Scotland’s Citizens served as a transition to the developing Digital Health and Care Strategy. The Plan acknowledges that one familiar device, or platform, can carry out multiple functions rather than citizens having to use multiple and specialist devices. It describes the overall aim for TEC: adding value to redesign of service processes, improving personalised and preventative care through more mobile, responsive and tailored solutions for those with care needs and their carers, and supporting citizens to make greater use of technology to manage their own health and wellbeing at home and in the community.

Continuing to invest in the TEC Development Programme was one of the four main areas in the National Action Plan, along with Innovation, International Engagement and Cross Cutting Enablers such as research and evaluation, standards, and education. Considerable progress has been made on the eight actions that were identified for the TEC Programme.

• Technology Charter for People Living with Dementia and resources developed;

• Procurement and launch of a national model for video enabled consultations;

• National Framework for Home and Mobile Health Monitoring published;

• National computerised cognitive behavioural therapy (cCBT) established in partnership with NHS24;

• Work is ongoing to ensure procurement frameworks are fit for the future;

• Seeking sustainability through strategic planning and developing the business case;

• Published reports of independent studies addressing key strategic issues.

To improve health and wellbeing outcomes for Scottish citizens;

To expand and integrate the effective use of TEC as a sustainable & cost effective component of our health, housing and

care services;

To promote greater use, integration and sharing of technologies across sectors

and services;

To raise awareness and promote the digital agenda within health, housing &

social care;

To achieve sustainable and manageable growth in the number of individuals

supported by TEC;

To routinely use measurement and evaluation for continuous improvement

and service planning.

To embed TEC within strategic planning and service (re)design processes;

Although TEC can be appropriate for people with all levels of need, the TEC Programme guidance in Year 2 and 3 noted that there is greatest scope to make an impact at the high volume, lower complexity level of care and support to enhance citizen wellbeing. Applicants were encouraged to focus on technology enabled prevention, early intervention, and supported self management, in line with the emerging focus on digital health and wellbeing and


Telecare Feasibility

In 2016, the Scottish Government and COSLA commissioned Deloitte to carry out a feasibility study on extending access to telecare, with a particular focus on people aged over 75 years and people with dementia. Current coverage for telecare is around 20% of the over 75 population in Scotland. Deloitte estimate that around 33% of all over 75s could potentially benefit from telecare with a benefit to cost ratio of 1.2:1 at 1 year rising to 1.8:1 by year 3. Around two thirds of the benefits anticipated would accrue to the social care sector mainly as a result of preventing or delaying admission to long term care. The report can be accessed here.

Anticipating Future Demand

The TEC Programme commissioned National Services Scotland Information Services Divisionto project the number of people in Scotland who will be living with a long term condition. The report and the accompanying data-sets provide useful intelligence on anticipated future demand for HMHM and digital platforms.

Approach to Evaluation

In 2017, Just Economics carried out an independent review of the evidence and evaluations on TEC in Scotland in order to provide recommendations on the approach to evaluation in future. The researchers reported that the degree of technology development, deployment and adoption observed would have been unlikely in the absence of the TEC Programme. The data review found a strong commitment to measurement, evaluation and use of data to support continuous improvement. The authors noted emerging evidence for the value and impact of TEC with solid evidence for the benefits of HMHM and Telecare and developing evidence for digital platforms and Videoconferencing that are still at earlier stages of implementation. The report highlighted that the TEC Programme is applying implementation strategies that are consistent with international best practice. It recommends the development of guidance, resources and the creation of in-house expertise to support measurement and evaluation using approaches that address the need for flexibility, speed, adaptability, attention to contextual factors and the evolving nature of TEC interventions. The summary report can be accessed here.

Fig 2 Citizens benefitting from TEC90,000

80,000

70,000

60,000

50,000

40,000

30,000

20,000

10,000

0Mar 15 Jun 15 Sep 15 Dec 15 Mar 16 Jun 16 Sep 16 Dec 16 Mar 17 Jun 17 Sep 17 Dec 17 Mar 18 Jun 18 Sep 18

84,000 citizens

Monthly

Cummulative

End of Y1

End of Y2

End of Y3


The Plan provides the overall narrative for health & social care in Scotland, and specifically recognises that in order to achieve the 2020 Vision there is a need to ‘continue to evolve our health and care services to meet new patterns of care, demand, and opportunities from new treatments and technologies.’ The Delivery Plan focuses on three key areas, the so-called ‘Triple Aim’, which the TEC Programme is well aligned with:

• Better Care – right care from the right person at the right time in the right place: For example, video enabled consultations and remote monitoring allowing optimal decision support and effective care at home or closer to home, with a focus on improved outcomes for the individual;

• Better Health – a greater focus on anticipation, prevention and self-management with Home and mobile health monitoring for long term conditions and digital platforms that provide information, advice and support for self-management and digital telecare supporting enabling greater anticipation and prevention of admissions;

• Better Value – effective use of resources and a shift to primary and community care is seeing greater use of Remote monitoring and video consultation; Telecare solutions enabling sustainable and enhanced care and support at home, reducing the need for long term care; a move to national licencing costs; shared learning and knowledge transfer to reduce duplication of effort and accelerate implementation.

Within the Delivery Plan, TEC Programme activity supports a number of areas, such as:

• helping to shift resources into the community, supporting new models of care and support in home care and in community care – with a particular focus on prevention and self-management – and social care reform;

• improving outpatient care by increasing virtual access as part of The Modern Outpatient through, for example, spreading the use of Attend Anywhere;

• supporting the aspirations of the National Clinical Strategy for Scotland, with its focus on person-centred and community delivered care, enabled by increased adoption of modern technologies to support greater self-management and independence;

• supporting Realistic Medicine by empowering patients with a better understanding of their conditions and reducing the number of unnecessary appointments;

• supporting improvements in mental health with two TEC initiatives now core commitments in the 10-year Mental Health Strategy – including the roll out of cCBT;

• leading on the technology components of the Active & Independent Living Improvement Programme;

TEC and the Health & Social Care Delivery Plan

The Health and Social Care Delivery Plan published in December 2016 reaffirms the 2020 Vision and sets out actions to enable the people of Scotland to live longer, healthier lives at home or in a homely setting.


• supporting the development of the Digital Health & Care Strategy to “bring together all IT, digital services, tele-health and tele-care [technology enabled care], business and clinical intelligence, predictive analytics, digital innovation and data use interests in health and social care.”

Investing Wisely

Over the three years 2015-2018, the TEC Programme has overseen additional investment of around £25 million to support activity at both national and local levels. National capacity established an enabling and technical infrastructure to develop implementation tools and guidance, support knowledge sharing, and to commission critical pieces of research, monitoring and evaluation. This capacity benefits local systems as it provides technical and subject expertise and additional improvement support to help all partners test and scale up TEC solutions.

Funding for TEC partnersOverall, 43 partners across Scotland received TEC funding. The majority were territorial NHS Boards, Local Authorities and their Health and Social care Partnerships (HSCPs) but TEC investment also funded initiatives by national partners such as the Scottish Fire and Rescue Service; NHS 24; the Scottish Federation of Housing Associations (SFHA); Alzheimer Scotland; Quarriers; Coalition of Care and Support Providers in Scotland (CCPS); The Alliance; Digital Health and Care Institute (DHI) ; Young Scot and Academia.

As expected, most of the local funding has been used to expand tried and tested HMHM and Telecare solutions as these have the most developed evidence base. However this has been balanced by developmental work on video-enabled consultations and digital platforms

In collaboration with local partners, TEC funding levered additional multi-million investment to Scotland from European research and cross border funding programmes and Scotland was one of only 8 European regions awarded ‘4-star Reference Site’ status by the European Commission’s Innovation Partnership for Active & Healthy Ageing. This was for excellence in development, adoption and scaling up of technology enabled care in an integrated care environment.

• supporting a more active Scotland through initiatives such as video exercise classes from community sports centres into care homes;

• helping to progress recommendations within the review of Maternity & Neonatal Services through greater use of TEC and supporting the aspirations of children and young people by working with Young Scot;


1. Home and Mobile Health Monitoring

Over 17,000 more citizens have benefited from the

introduction of HMHM since 2015.HMHM, sometimes referred to as “Telehealth”, is the use of digital remote monitoring technology to enable patients outside of hospital to receive, record and relay clinically relevant information about their current health and wellbeing. It is used to inform or guide self management decisions by the patient and to support diagnosis, treatment and care decisions by professionals.

The National HMHM Community of Practice shares information from HMHM learning events, including numerous case studies and posters, and key deliverables such as the 2018 National HMHM Evaluation report, and the framework for the National Home and Mobile Health Monitoring Service Model (Release 1.0, 2017).

This framework presents a highly intuitive and generic conceptual model for HMHM that:

• consolidates learning from early adopters and service pioneers in Scotland and applicable learning from other parts of the world, especially Europe and North America;

• establishes a foundational service template designed to be scalable and efficient when applied in the context of services in Scotland;

• provides a starting point from which new experiences based on common principles can be used to drive improvement in this field of practice.

Figure 3 shows how the model groups citizens into tiers according to the intensity of their healthcare

needs and the health resource utilisation and per capita costs at each tier. To date, HMHM is most effective when focussed on Tiers 2, 3 and 4.

The HMHM work stream and community of practice develped a national dataset to report and reflect on the changing patterns of use of HMHM in Scotland. This data is submitted quarterly to the Information Services Division (ISD) of National Services Scotland and the annual reports can be found here. The latest report shows a steady growth in new citizen users of HMHM with 8,824 new users in the reporting period Oct 2017 to Sep 2018. Figure 4 shows the month on month expansion of access to HMHM in Scotland.

The HMHM service users are generally adults with long term conditions. Over 80% of users are Tier 2: supported mainly in the community by Primary Care and other community based services with very occasional or ‘exceptional’ involvement with hospitals. Only around 1% of users are Tier 4: people who have complex and enduring specialist requirements and are typically supported by a multi-disciplinary team in a community setting.

In line with the strong evidence base, the most common target for HMHM was blood pressure monitoring. Figure 5 shows the range of other conditions targeted, particularly diabetes, Chronic Obstructive Pulmonary Disease, and mental health. Other applications include Audiology, Brain Injury, Cancer, Continence, Dementia, Frailty, Heart Failure, Muscular Skeletal, Other Cardiac, other Respiratory, Renal, Rheumatology and Stroke.

The national framework highlights the importance of flexible and time limited deployment. The national data shows that local use is adhering to this national guidance whereby people receive HMHM support for periods ranging from a few weeks to around 9 months. Figure 6 shows the principal reason for discontinuing HMHM monitoring. For three quarters of users, discontinuation is due to completing a planned intervention and stepping down to self management. Only 7% of users declined to continue the HMHM service.

TEC Highlights


(hospital based monitoring)

Acute Care

(monitoring and intervention outside of

healthcare settings)

Home and mobile health monitoring

(interactive education sessions, health vital

monitoring etc)

Self-monitoring

(Websites, patient portals etc)

Enabling Information Systems

Home and Mobile Health Monitoring

Tier 1Preventative wellbeing and

health management

Tier 2Primary Care

Tier 3Specialist Care (Outpatient)

low – medium risk of hospitalisation

Medium – high risk of hospitalisation

Tier 4Complex Care (Community)

Tier 5Acute Care

£

£££

£

Health resource intensity

Relative patient population

Per capita costs

(hospital based monitoring)

Acute Care

(monitoring and intervention outside of

healthcare settings)

Home and mobile health monitoring

(interactive education sessions, health vital

monitoring etc)

Self-monitoring

(Websites, patient portals etc)

Enabling Information Systems

Home and Mobile Health Monitoring

Tier 1Preventative wellbeing and

health management

Tier 2Primary Care

Tier 3Specialist Care (Outpatient)

low – medium risk of hospitalisation

Medium – high risk of hospitalisation

Tier 4Complex Care (Community)

Tier 5Acute Care

£

£££

£

Health resource intensity

Relative patient population

Per capita costs

Fig 3 HMHM tiered model

Tier 1: Citizens are self-managing and maintaining their good health and wellbeing generally outside of healthcare, increasingly with support from digital platforms and wellbeing apps.

Tier 2: Citizens are supported mainly in the community by Primary Care practices and other community based services with very occasional or ‘exceptional’ involvement with hospitals.

Tier 3: Citizens have an extended or enduring condition(s) or health problem and are likely to have period episodes of care managed by specialists in ambulatory or inpatient episode.

Tier 4: Citizens have complex and enduring specialist requirements and are typically supported by a multi-disciplinary team in a community setting.

Tier 5: Citizens have frequent need for acute healthcare outside of a community setting and are largely or wholly dependent on hospital services.


Fig 4 Monthly cumulative total number of new users of HMHM Oct 2017 – Sep 2018. source ISD report

Fig 5 Use of HMHM for range of conditions – source ISD report Oct 2018

Fig 6 Reason for discontinuing HMHM – source ISD report Oct 2018

10,000

9,000

8,000

7,000

6,000

5,000

4,000

3,000

2,000

1,000

0Oct 17 Nov 17 Dec 17 Jan 18 Feb 18 Mar 18 Apr 18 May 18 Jun 18 Jul 18 Aug 18 Sep 18

Hypertension (N = 4192) – 8 Partners

Mental Health (N = 1670) – 4 Partners

General Health (N = 905) – 6 Partners

Other (N = 493) – 8 Partners

COPD (N = 457) – 7 Partners

Maternity (N = 369) – 4 Partners

Diabetes (N = 185) – 1 Partners

Not Known (N = 102) – 3 Partners

Categories with Less than 100 Users (N = 424)

Clinical Intervention Complete or Self-Managing (N = 4464)

Service Not Delivering Intended Benefits (N = 25)

Service Declined by User (N = 434)

Technical Issues (N = 30)

Alternative Service Provided (N = 148)

Moved Outwith Board Area (N = 0)

Deceased (N = 25)

Other (N = 28)

Not Known (N = 690)

76%

7%

1%3%

12%

48%

19%

10%

6%

5%4%

2%1%

5% 0%0%

0%


The following short case studies highlight the range of benefits being achieved for people and for local systems. More examples of local implementation are in the HMHM posters brochure that can be downloaded from the National HMHM Community of Practice.

Adam lives with cystic fibrosis and has to work hard to keep up his calorie

intake to get the right nutrients and maintain a healthy weight. Still at school, he wants to do the same as everyone else his own age; difficult with a feeding tube in place. He has to make sure he is home early enough in the evening to allow the tube to do its work. The Oral Nutritional Support Service in NHS Tayside introduced him to the Florence system. Adam and his dietitian developed a tailored protocol to remind Adam to eat snacks and give him tips for weight gain and nutrition. Adam used Flo’s ideas and methods to set up personalised prompts and reminders. ‘I have managed to achieve a significant weight increase which led to the removal of my gastrostomy in my stomach which I was wanting desperately. Flo was a great help!’

NHS Lothian introduced Florence for patients with hypertension and

developed a method to securely extract data from the Florence website and deliver it in a report to GP-practices through their routine document handling system, Docman. Patients like the new system, feel more engaged in their care and appreciate not having to attend the surgery. Clinicians appreciate the Docman reports as the need to log on to a third-party website requiring recall of logons and passwords had been a barrier to adoption of Flo in Lothian. Over 50 practices and 2000 patients have taken part. The number of people with poorly controlled BP fell from 13.6% to 3.4%.

NHS Ayrshire and Arran developed and delivered new HMHM pathways

for Hypertension Diagnosis, Hypertension Medication Titration, Newly Diagnosed COPD Self Management, Step-down COPD, cCBT and Diabetes Insulin Self Management. A further 4 FLO protocols are ready to be tested for MSK pathway, Smoking Cessation, Weigh to go and Incontinence. After a very successful outcome achievement study including patient focus groups and staff survey, feedback from patients and clinicians has been positive. Evaluation of impact of HMHM has shown considerable cost savings in Primary Care contacts, emergency admissions and bed days. 95% of GP Practices are trained and signed up to using TEC for diagnosis or monitoring of Hypertension BP monitoring, cCBT, and COPD.

NHS Lanarkshire has secured additional funding to scale up BP

monitoring in a collaboration with the TEC Programme, British Heart Foundation, NHS Lothian and NHS Western Isles. Flo is also used to support health improvement, mental health and other health and wellbeing challenges including a maternal and infant feeding pathway improvement study using both Flo and Attend Anywhere. Over 5,000 patients have used the Flo text platform. 77 GP Practices and 2,000 patients have used Flo to monitor and manage blood pressure at home saving travel and appointment time.

East Renfrewshire HSCP began using a Florence hypertension protocol in Sep

2017 and have now recruited over 300 patients – saving around 900 GP appointments. Their advice to others: Break the huge scary tasks down into manageable chunks and use the successful achievement of these to motivate you through the next one!


Small improvements in self-management can make a big difference

to an individual. For example, advances in treatment mean that people with Multiple Sclerosis can now receive disease modifying drugs that are very effective but require regular blood tests and monitoring for side effects. One person in the Western Isles experienced worsening symptoms as a result of missing vital appointments for monitoring and titration of their drugs. In the 6 months prior to TEC they missed 60% of appointments. In the 12 months after TEC, they attended all visits, had better symptom control and their side effects were dealt with.

NHS Highland designed a Florence protocol to act as an electronic asthma

action plan (eAAP). It requests peak flow readings twice a day, and responds to tell the patient which Zone they are in (Zone 1 to 4) and what action they should be taking. To make the protocol patient centred, different versions are based on a range of best peak flows (from 250 up to 700). A patient whose peak flow is below 50% of their best peak flow is told to dial 999 or to call their GP urgently and what steps to take until help arrives. Florence is also being used as a clinical intervention for 25 patients who attend the Difficult Asthma clinic, in order to objectively monitor their response to biologic medication. This enables the respiratory service to evidence patient response to treatment. 150 patients enrolled to date engage better with healthcare services, are self-managing more effectively, recognise deteriorating symptoms earlier and seek appropriate assistance in a timely manner. Evidence also shows a dramatic reduction in hospital admissions for acute asthma, a reduction in hospital bed days and a reduction in GP/nurse contacts.

A 76 year old female from West Dunbartonshire with COPD lives at home

alone with good family support, no care package in place and no district nurse input. She uses Flo and has a Community Alarm to provide extra support particularly out of hours. By using TEC supports she feels more able to stay at home, to start treatment without delay and had better symptom management. Since early 2017 she has had 3 exacerbations successfully managed at home by the COPD TEC service without interventions from hospital which was her previous usual pathway.

Mark from West Lothian is 13 years old and has Asperger’s Syndrome and a speech and

language disorder that make processing and understanding conversations and verbal instructions difficult. Mark works and responds well communicating via mobile phone. Although his mum administered his medication, she felt this was a life skill he needed to learn. Using Flo, a daily text message was set to prompt Mark to take his medication at a regular time. Mark is now more independent of his parents /care givers, takes his medication at a regular time, settles quicker in the evening and has a more peaceful sleep. Consequently he is less tired at school and his mental wellbeing has improved. He was able to join in an overnight school trip, and to go on sleepovers with his friends. Mark’s parents feel less anxious resulting in better sleep patterns, a stable routine and improved wellbeing for the entire family.

Argyll & Bute HSCP, a very dispersed community including 23 islands,

introduced the Florence text monitoring service at the end of 2015 and have developed protocols for pain, pelvic floor, falls, COPD, anxiety, podiatry, relaxation, hypertensions, smoking cessation, increasing activity and weight management. Flo has been embedded in BP diagnosis pathway and in the Diabetes education programmes such as Xpert and ABBIE 795 people have accessed Flo using 45 different protocols


2. Video enabled services

Almost 5,000 more citizens benefited from video enabled

services and support since 2015This work stream aims to expand the use of video conferencing (VC) technologies for health and care consultations.1 The initial focus was on increasing use of traditional VC systems such as Cisco and Polycom devices. In the first year, a range of projects were established to improve communication between the health and social care sectors, support the use of VC consultation with outpatients and develop video mediated clinical services to care homes in Borders, Lanarkshire, Angus and Midlothian.

Angus HSCP developed the Video Active pilot to use NHS VC equipment to

beam seated exercise classes live from Sports Centres to Angus Care Homes, community venues and individuals’ homes. The initiative aimed to

• Increase physical activity in care homes;• Increase access to physical activity for

people living in rural Angus;• Make the best use of resources; by beaming

one class out to different venues.

Over an 18 month period, around 30 people benefitted each week from being able to participate in exercise classes they would not have been able to otherwise. The equipment enabled a case conference at local care home during which 20 residents were reviewed and medication changed. These case conferences will now recur routinely. The remaining equipment will be deployed to community hospitals to broadcast pulmonary rehabilitation classes to three venues. At the end of the pilot, the Leisure facility decided to cease broadcasting their classes. Recognising the value residents had gained from participating, the care home in Forfar and Kirrieconnections (a local dementia support centre) are leading the roll out of a new version of the Video Active across Angus using a non NHS VC network.

1 Often referred to as ‘telemedicine’, a term we deliberately refrain from using in Scotland due to the cross-sectoral nature of the opportunities presented by video access to services.

Midlothian HSCP introduced a VC enabled training network for their care

homes staff. Care home staff turnover is high and the ability for homes to release staff for offsite training had proved consistently limited. In addition, delivering the same training to multiple sites was inefficient. The project launched in February 2017 and has been a huge success, increasing participation in training and reducing travel. The project allows staff to attend training within their care home delivered remotely using the equipment. It means staff do not have to take time out to travel to sessions, and training providers can reach more staff in one go. 11 care homes participated and training reached teams supporting 556 residents. In the first 6 months 12 sessions were delivered reaching 768 participants (average 64 per session).

In Lanarkshire, 20 care homes have been set up with cisco devices to enable

VC. Over 100 health staff/teams have been set up with jabber enabling mental health, AHPs and GP practices to link in to the care home for virtual ward rounds and consultations. In 2018 they introduced Attend Anywhere and training for Community teams, Diabetes, paediatric dieticians, occupational therapists, physiotherapists, speech and language and health visitors/midwives/weaning support. Community staff quickly embraced the concept of using VC to provide an improved service to their patients and staff and are testing Attend Anywhere in patients’ homes for multidisciplinary case discussions /consultations. Patients are offered the option of linking in using their own devices or with the presence of one of the multi-disciplinary team e.g. nurse or support worker linking to a physiotherapist. Two examples are:

• A specialist respiratory physiotherapist having a VC session (for control of asthma) with a child and both parents in their own home avoiding extensive travel across Lanarkshire – all were delighted!


• An 85 year old having her treatment review, using her own ipad, by the community team physiotherapist, support worker and with her daughter being able to link in from her workplace to see and hear the outcomes first hand.

Staff and patients/carers immediately saw the benefits of having a live link with good visuals. Benefits observed include reduced travel, reduced time, engagement with “hard to reach” patients, avoiding time off work / school and enabling carers to participate where appropriate. Plans are being developed to extend the use of Attend Anywhere to additional care homes and to enable remote consultations with prisoners in HMP Shotts. Watch the video at https://www.youtube.com/watch?v=ed5Rb9Bcs-k&feature=youtu.be

A GP practice in Dumfries and Galloway introduced Attend Anywhere

to a local residential Care Home using an iPad to enable the video consultations to take place in residents rooms. The GP advised reception staff to triage calls so that suitability for video consultations could be identified. On the occasions where it has been used, the video consultation saved visits. The Care Home has been able to use the iPad for different things with residents and not just for video calls. A second care home without Wi-Fi access has a laptop setup in a Treatment Room. Community Mental Health, Speech and Language and Dietician teams and Respiratory teams are testing use of Attend Anywhere. Two new video clinics (Joint School and Chronic Pain) have been established using the National VC network and Lync between Dumfries and the Galloway Community Hospital in Stranraer reducing need to travel.

Attend Anywhere

In late 2015, the TEC Programme team became aware of a new product, Attend Anywhere. This uses browser based technology to deliver a simpler video consulting solution that matches the consulting workflow. The product was developed by Health Direct Australia, a government funded organisation that provides services similar to NHS 24 such as out of hours care, nurse triage and a range of help lines. Their aim was to develop a video consulting system that could compete with the ease of use of traditional telephony systems.

The Attend Anywhere system was procured by Scotland in October 2016 and formally launched by the Cabinet Secretary for Health and Sport in December 2016. This has been a game changer in terms of the adoption of video enabled consultations. The system provides a video clinic environment that can be accessed by a member of the public using a web browser on their own device, be it a laptop, tablet or Smartphone (Figure 7). It is purpose built to meet the needs of the health and care sectors, and can deliver VC services at scale.

By March 2018, Attend Anywhere clinics had been established in 13 NHS territorial boards as well as HSCPs and third sector organisations. It is also being tested by the Golden Jubilee National Hospital and by NHS 24. NHS Lothian has now expressed an interest in using the service following a review of infrastructure standards.

A total of 107 organisational units have been set up, each managed by an administrator, and covering a wide range of health, care and third sector clinical and care services. Services are provided via a ‘Waiting Area’ or front door where the provider can ‘collect’ the patient or client. Each waiting area represents a different service including consultant led outpatient clinics, AHP services, primary care and third sector providers. A consultation is defined as a meeting between a service provider and a service user that lasts longer than 2 minutes. The number of consultations has increased significantly since the first episode in February 2016.


All three Island Boards are making extensive use, saving flight or ferry transfers. Other examples of significant use of Attend Anywhere include:

• NHS Highland: Out patient (OP) services at Caithness; Weight management;

• NHS Grampian: Sexual health services; Gastroenterology OP; Paediatrics; CAMHS;

• NHS Tayside: Paediatric Diabetes; Adult Psychology; Dermatology;

• NHS Borders: Out of Hours services to care homes;

• NHS GGC: Dermatology; Neurology; Diabetes OP;

• NHS Lanarkshire: Paediatric; Renal; Respiratory; Diabetes; Rheumatology.

98% of users surveyed at the end of their consultation said they would use the service again. They indicated that, on average, they had saved an 85 mile round trip. Figure 8 shows other benefits reported by service users. Of 465 provider responses, 49% stated avoiding provider travel.

More information on implementation experience can be found in the VC using Attend Anywhere Progress Report and in presentations and videos of its use in the Modernising Outpatients Programme and under the NHS Near Me brand in NHS Highland.

Fig 7 The Attend Anywhere model

There are currently 257 Attend Anywhere waiting areas created.

103 of these have been active in the last quarter.

Over 1900 Attend Anywhere consultations have been

held to date.


Fig 8 Attend Anywhere benefits for service users – source end of consultation on line survey

Some third sector organisations have made significant use of Attend Anywhere

Revive MS Supportover 200 consultation held to date. Services include specialist nursing support, counseling, alternate therapy and speech and language.

Rape Crisis Grampianover 70 sessions held to date. Feedback has been very positive, with the waiting list of one provider reduced by two thirds.

Care-MNDFourteen consultations have been held to date.

Others at an earlier stage of introducing the system include CHAS (Children’s Hospices Across Scotland), Alzheimer Scotland, Stroke Association Scotland, Scottish Epilepsy Centre, Relationships Scotland Orkney and Spina Bifida Hydrocephalus Scotland.

0 50 100 150 200 250 300 350 400

Saved travelling

Did not have to take time off work

More convenient

Did not have to take someone with me

Because of my condition, it was safer / easier

Saved me money

Took less time

Did not have to arrange childcare / care of a relative

I did not have to wait as long for an appointment

Other


3. Telecare

Around 40,000 more citizen have benefited from Telecare since 2015Telecare offers individuals, families and carers, security and peace of mind. It enables people to stay independent in their own homes for as long as possible. Although now well established across Scotland with approximately 160,000 people currently in receipt of telecare2, considerable variation still exists across areas. This work stream aims to ensure that Telecare is a routine response and is embedded in upstream prevention, support for people at transitions in care, and for people with dementia and their carers.

Progress has been made on four interdependent strands of Telecare activity: • Establishing a robust Digital Telecare

Programme;• Exploring Next Generation Solutions;• Community Building and Knowledge

Exchange;• Data and Analysis.

Analogue to Digital Transformation (A2DT)

The TEC Programme, with Local Government Digital Office and CoSLA, commissioned a study to understand the scope and benefits of switching telecare provision from analogue (i.e. through traditional telephony connections) to a digital service. The study highlighted the challenges associated with the current fragmented landscape of 22 Alarm Receiving Centres and a wide range of telecare providers and equipment. TEC leads are facilitating a ‘once for Scotland’ approach, involving all Scottish HSCPs, Housing, Industry and Academic partners, to exploit the opportunity for digital transformation and ensure the sustained and safe delivery of future Telecare Services. Partnerships are participating in Action learning sets to support them to develop their Road Map

2 Estimated, based on official figures for local authority commissioned/provided telecare, housing association use, supported accommodation and private provision.

to make the required local changes. The steps that Glasgow City HSCP is taking to prepare their A2DT Road Map are outlined below.

A telecare financial framework is currently under development to meet the challenges of relocation of control centre, A2DT, new technology, support services etc.

The reformed system which is currently being rolled out includes:

• Online referral access;• Specialist support workers based in

localities and hospitals;• Development of online training

modules/ tutorial supports;• Communication strategy;• Establishment of an ethical

framework;• Widening access to emerging

technologies;• Establishment of a virtual store/

consumer pathways;• Commissioning of Technology

Enabled Care Support Services to call off for Glasgow’s 2019 Social Care Framework;

• Engagement of local RSLs through Technology Enabled Living Events.

Next Generation Solutions

Telecare services have largely remained unchanged, delivering a safe, reliable and trusted service for over 40 years. The TEC Programme identified an opportunity for a more ambitious programme to embrace emerging innovation in consumer technology including wearables, smart voice interaction systems, big data and artificial intelligence. In addition, Digital Telecare data can be linked with other data sources to support value based care. Richer data sets and the emergence of Artificial Intelligence and Big Data will support a more proactive approach with opportunities for earlier intervention and integrated solutions.


Community Building and Knowledge Exchange

The Telecare Programme convened dedicated Action Groups to focus on Falls, Overnight Support and Data. These learning communities work collaboratively to explore challenges, share best practice and experiences to improve efficiency and outcomes from Telecare.

Examples of the work to date include:

• Embedding Telecare within redesigned care pathways for people with dementia, and individuals at risk of falls;

• Support for Telecare enabled redesign of overnight support services;

• Development of an on-line Telecare Self Check and Signposting Tool for citizens;

• Awareness raising, public engagement and service education about Telecare.

An overview of the activity on these topics can be accessed at the Telecare section of the website of the Scottish Centre for Telehealth and Telecare and from the presentations at the March 2018 national telecare event.

Telecare Data and Analysis

The shift from analogue to digital Telecare presents a unique opportunity to establish robust and standardised data collection processes from the outset. Opportunities for automated national data collection will generate efficiencies and support the use of data analytics within preventive and proactive care.

The TEC Programme is looking ahead to prepare for these emerging opportunities. In the meantime, it has progressed work to improve and standardise the existing Telecare data collection. The Telecare Data Action Group developed and launched a national Telecare benchmarking collection template and definitions document. Information on the national Telecare dataset and benchmarking activity can be found here.

ISD prepares an annual report of the quarterly Telecare monitoring returns. The latest report can be found here. It highlights the steady expansion of Telecare since quarterly reporting began in January 2016 (Figure 9).

Fig 9 Cumulative increase in new Telecare users Jan 2106 – Sep 2018. – Source ISD report Oct 2018

70,000

60,000

50,000

40,000

30,000

20,000

10,000

02016 Q1 2016 Q2 2016 Q3 2016 Q4 2017 Q1 2017 Q2 2017 Q3 2017 Q4 2018 Q1 2018 Q2 2018 Q3


New telecare users are almost exclusively adults, with the majority being over 75 years (figure 10). A small group of young people are being introduced to telecare, often as part of a redesign of their overnight support package.

Figure 11 shows the breakdown of the different Telecare equipment provided to new users. The number of activity, falls, bed, personal and GPS monitors reflect growing interest in enhanced telecare. Joint working with Scottish Fire and Rescue Services is helping increase provision of heat and CO2 Alarms.

Overnight support

Telecare can enable redesign of traditional overnight support for people who need;

• support – where a person has a significant mental health problem or learning disability that means it is difficult for them to be alone overnight;

• reassurance or a check-in call/conversation;• help for medication, going to the toilet,

managing continence, turning in bed;• safety and security – where a person might

wander or leave the house.

Fig 10 Cumulative total of new users by age band Jan 2016 – Sep 2018 – source ISD report Oct 2018

Fig 11 New Telecare Installations Jan 2016 – Sep 2018 – source ISD report Oct 2018

25,000

20,000

15,000

10,000

5,000

02016 Q1 2016 Q2 2016 Q3 2016 Q4 2017 Q1 2017 Q2 2017 Q3 2017 Q4 2018 Q1 2018 Q2 2018 Q3

Community Alarm (N = 58060)

Falls Monitor (N = 13008)

Activity Monitor (N = 3180)

Bed Monitor (N = 2804)

GPS Monitor (N = 1021)

Other Personal Monitors (N = 5099)

Smoke, Heat and CO2 Alarm (N = 30798)

Flood Detector (N = 443)

Other Environmental Monitors (N = 4006)

49%

11%

4%

26%

3%2%

1%

0%4%

0 to 17

18 to 64

65 to 74

75 to 84

85+

Unknown


TEC partners are exploring how enhanced telecare and next generation solutions can transform overnight care.

East Ayrshire HSCP is implementing creative TEC-enabled models of

overnight care. DD is a 41-year old woman who lives with a rare genetic condition and a moderate learning disability. She had never lived on her own. For some time it had been assessed that alternative overnight arrangements may have been viable but there were a number of challenges:-

• DD and her family’s anxieties – she had removed TEC devices previously;

• risks from the community and environmental risks within the home;

• Staff training around TEC.

Changes were made to the support package over a planned process of around 8 weeks in which DD was fully engaged in her assessment and care planning. She attended regular meetings and was fully involved in the selection and installation of a bespoke TEC package – video doorbells, activity monitoring, alarm equipment and ‘whatsapp’/video calling. A comprehensive multi-agency risk assessment was completed and DD’s supports are now jointly provided between two care providers. DD’s overnight supports are now provided via a TEC-enabled responder service. DD and her sister (Guardian) have reported that DD feels very proud of her achievements, and has associated the change process with ‘growing up’. DD has dealt well with some incidents– such as her cat going missing and a night-time power cut in the area.

Falls

A telecare response for noninjured fallers is central to the Scottish Ambulance work on falls and frailty as highlighted in this video from Forth Valley https://youtu.be/QyDF4eW8ZNY TEC work on falls also links to the Falls Assistant digital platform – an online falls prevention and self-management tool for people who want to reduce their risk of falling – developed as part of the European funded Smartcare programme. Telecare can help to increase confidence and sense of security for those who are at risk of falling. Home sensors can be used to help understand activity patterns to both assess risk and optimise independence.

In South Ayrshire Mrs P completed an online self-referral form after she had

fallen in her home and was unable to get off the floor by herself. She had lost a lot of confidence and had become frightened to do everyday things that she done previous to her fall. The Telecare Officer called Mrs P and asked questions to ensure she got the appropriate equipment. She referred Mrs. P to the local falls clinic to reduce risk of further falls which she accepted. The Mobile Attendants installed a basic package of community alarm, smoke detector and pendant the following day. Mrs. P was very happy and felt more secure. This gave her confidence knowing there was someone to help her if she was unwell or hurt again.

A 97 year old West Dunbartonshire man who lived alone in a first floor flat

fell and broke his upper arm. After discharge from hospital he was missing meals, sleeping in an armchair, had 4 more falls in a week and often forgot his tablets. A 3 times a day home care package and basic community alarms were in place. He was reluctant to accept any support and his carer was unsure if it was safe for him to stay at home. The Canary system quickly identified a disturbed sleep pattern with frequent visits to the bathroom. (Diagnosed urine infection). The falls sensor was alerting in the auto mode. The client quickly recovered from the UTI and


the Canary system showed that he had a good routine – getting up in the morning, going to the bathroom, then the kitchen and settling in the living room with his breakfast and medication. Although he had to move out of this flat as unable to manage the stairs, he was assessed as capable of living in a sheltered housing property with minimal support. All parties were happy and the client continues to do well within sheltered housing. “with the old pendant system, my dad was not able to activate the alarm, however with the new equipment that was put in it automatically raised an alarm as well as help identify the UTI. The equipment is fantastic, great and everyone should have it. Without this equipment we would not have been able to support my dad at home.”

Perth and Kinross HSCP are using I-Care to help assess an individual’s

ability to remain independent. The kit contains 5 IR sensors to detect movement, 2 sets of door contacts, an electricity usage monitor, a pendant and a telecare receiver. The system constantly monitors and records activity to build a profile of the routine and can be used to assess if the accommodation is appropriate. The protocol offers an i-care assessment for 4-6 weeks without charge. Use by 39 people to date has prevented a number being moved prematurely from sheltered housing into care homes, saving costs and helping people to stay independent at home for as long as possible. In early cases admission to care could be delayed for typically around 6 months. “Our job is based on uncertainty and it’s great to have some definite data and clarity to work with’’. Community nurse

Dementia

The report of the Telcare feasibility study increased awareness of the opportunities to scale up Telecare for people living with dementia. A productive collaboration with Focus on Dementia Post diagnostic support work promotes consideration of TEC at an earlier stage of the pathway. Progress has been made on Safer Walking guidance and education, and on national standards for the use of Global Positioning technology (GPS). Case studies illustrate how Telecare is changing lives for people living with dementia and their carers, and the strategic redesign that is enabling expansion of Telecare to meet growing demand.

Ms. C is 78 years old and living with dementia in Lanarkshire. She lives

alone, a 40 minute drive from her brother. She had been a target of bogus callers with reports of money stolen. The TEC team supported Ms. C’s brother with installation of Ring video doorbell. This captured video images of the bogus caller and alerted Ms. C’s brother who contacted the police. The police identified and charged the bogus caller. Ms. C walks in her local area as part of her usual daily routine and sometimes gets the bus to the town centre. Sometimes she had difficulty finding her way home. A One Touch GPS Locator enabled Ms. C to continue her walking providing a means of locating her should she not return home as expected. When Ms. C’s dementia progressed she moved to sheltered housing where there were concerns about Ms. C leaving during the night. The team adjusted the GPS locator geofence in order that an alert was triggered as soon as she left sheltered housing. A Canary Care activity monitoring system was installed to assess Ms. C’s activity patterns in her home on her own and to alert her brother when the flat was unoccupied.


May contacted her social worker in South Ayrshire as she was struggling to

support her partner Jimmy who had dementia but was receiving no formal support. Jimmy had been found distressed and in pain after walking for over 6 miles; he would get up in the night and switch on the gas without lighting it and try to cook food without cooking utensils. May felt that she was becoming a prisoner in her own home and unable to cope with her caring role. The Telecare department supplied door sensors with May’s voice recorded asking Jimmy to return into the house until she returned home. Additional smoke detectors and heat detectors were installed and the switch for the gas made secure. A buddi (gps) system was supplied on Jimmy’s keys as he always took them with him when he left the home. May was happy to support Jimmy at home until he passed away in June 2017.

Inverclyde HSCP test of change in 2017 was to introduce Safer Walking using a

low cost GPS One Touch device for 20 people living with dementia.

• All users felt more confident and safer while walking;

• 50% of users activated the device between 5 – 10 times during the 6 week period;

• All users noted that the device gave the carer / family member reduced stress levels and additionally gave more independence to the user.

Glasgow HSCP invested TEC funding to review, upscale and improve

accessibility to telecare. The review looked at the end to end pathway from referral management, installation support and service delivery and was informed /steered by stakeholders including: Registered Social Landlords (RSLs); Scottish Care; Wheatley Group; Care Providers; and Community Health. The changes introduced were• Piloting of Localised Responder Services –

November 2015;• Roll out of GPS services – 2015 onwards;• Commissioning of Telecare Review –

Summer 2016;• Establishment of Telecare Reform Project

– March 2017 onwards;• Recruitment of Telecare Resource Workers

– September 2017;• Evaluation and mainstreaming Local

responder service into core service.

Results • Significant increase in referrals (1,000+ per

year);• Support to manage risks when service

users leave their homes unpredictably;• More supported/ better informed

practitioners;• Established stable financial framework to

manage the increased demand;• New services are avoiding premature

admission to long term care.


4. Digital Services and Platforms

Over 22,500 citizens have benefited from Digital Platforms

and Services since 2015 Funding was made available to NHS 24 to transition Living it Up from an Innovate UK development into a mainstream service offering within NHS Inform, which was completed in 2017. Development funding was also offered to the Health & Social Care Alliance for the continued development of ALISS, and a number of local digital services were funded as well, such as the scale-up of cCBT, the development of an online resource for parents and carers of young people (aged up to 25) in Scotland who have recently received a diagnosis of an eating disorder and are about to or have just started treatment (https://www.caredscotland.co.uk/) and the 415 Project to target isolation and loneliness in the over 65s.

At a national level, the initial focus was the creation of a framework for a national digital platform, learning from established initiatives in order to expand information, products and services to support Scottish citizens to have greater choice and control in managing their health and wellbeing. This work sought agreement on the nature, key components and outline technical architecture of a Digital Platform. The approved Definition and Services Report was shared widely across Scotland.

The next phase was to consider the business case for implementing the Digital Platforms proposals and specifically to:

• Develop a national platform; • Integrate into the national platform; • Onboard new digital services and products in

supporting self management.

Towards a Citizen Portal

In parallel with this work, the Scottish Government e-health policy team had commissioned the West of Scotland consortium of Health Boards to define a national approach to a sustainable health and care portal that is useful to patients, endorsed by clinicians and practitioners, technically achievable, secure, resilient and affordable. This Portal would provide a single point of access for patients and the public to their information and digital services. Initial scoping work recognised that data from monitoring devices needs to link back into core systems and also enable people to access their own information.

Given the clear connections and common supporting technical architecture it was deemed sensible to combine the Patient Portal and Digital Platform projects in a “build once, reuse” ethos. The resulting commission was to deliver the following products:

• Define the services that a Citizen Portal would deliver;

• Define a technical architecture that could deliver these services;

• Develop an Initial Agreement for the Citizen Portal;

• Define an incremental roadmap for developing and enhancing the Citizen Portal.

A national project board was formed to ensure that the solution specified and eventually delivered is national. These products were developed from considerable citizen and clinical input, as well as looking at established solutions and examples from other jurisdictions.

In October 2016 the TEC Programme Board agreed to fund a Proof of Concept for a Health and Social Care Services portal. This work was progressed from late 2017 to early 2018. Public engagement and user testing has been led by the Health and Care Alliance and by the Digital Health and Care Institute (DHI) through their Innovation Network for Digital Health and Care (inDHC).

User testing was undertaken on appointment bookings, and live links established for


correspondence and links to GP systems. Limited feedback received from users was positive. However, the TEC Programme Board agreed that the focus should now be beyond health and social care users and consider the wider needs of citizens.

The proof of concept health and social care platform is providing a test bed for a number of critical innovation and transformation projects currently underway. These developments require a digital platform in order to integrate securely with NHS systems and to ensure that patient data is structured in line with agreed standards. The fully supported platform will provide a pathway for innovation projects to reach a fully operational state in a live environment, improving their likelihood of achieving operational status at scale. It will also allow an ongoing West of Scotland / DHI innovation process that can:

• Test and operationalise standards under consideration;

• Stimulate the market to work to an open platform approach aligned with standards;

• Stimulate redesign to propose new service and business models for joint value;

• Potentially leverage further additional funding (from beyond Scotland) for the shift.

The West of Scotland e-Health teams and DHI will work closely with the NHS Education for Scotland’s Digital Agency to develop the national digital platform in line with Domain E of NHS Scotland’s Digital Health & Care Strategy.

The design work for the Citizen Portal will build on the learning from:

• the Living It Up (LIU) initiative, now transitioned to a landing page on NHS Inform;

• work with Young People to explore how digital technology can tackle their priorities;

• two established national patient platforms – Renal View and My Diabetes My Way;

• roll out of computerised Cognitive Behaviour Therapy (cCBT) across Scotland;

• citizen platforms that support independent living.

Young Scot In December 2016, Young Scot’s

Healthier Scotland Youth Investigation Team delivered their report on “Creating a Healthier Scotland”. This report explored what really matters to young people about health and social care and identified four key themes to be tackled:

• Education to live healthy lives; • Stigma – introduce a zero tolerance system; • Relationships with professionals

–accessible services and effective communication;

• Eating and fitness – aim to encourage healthy lifestyles and behaviours early.

During 2018 the TEC Programme and Young Scot have explored how digital technology can tackle these themes. Ideas workshops with young people have generated the following suggestions: Augmented Reality App – to encourage users to explore their community to increase fitness improve mental health, and link to Young Scot Rewards and ‘Connect Your Tech’ capability. Digital Doctors Surgery – website with comprehensive information on every GP surgery, online appointment booking, and remote video appointments. Mental Health Chat Service – digital live chat with a mental health professional, building on Young Scot’s Infoline and their Youth Commission on Mental Health. Health & Wellbeing Online Resources – a one-stop-shop to provide easy to understand information and guidance on a wide variety of mental and physical health topics

The report can be found herehttps://www.digihealthcare.scot/home/resources/technology-enabled-care-tec/tec-news-resources/


My Diabetes My Way (MDMW) This is the NHS Interactive website for

people with diabetes and carers. It contains validated multimedia resources to improve self-management and offers access for its users to clinical data, using information captured via SCI-Diabetes. The platform is funded by TEC and the Diabetes Programme in Scottish Government. 30,367 people are enrolled in MDMW to date across all 14 territorial boards. A short video describes the experience of a man with diabetes who uses the MDMW site. The further development of MDMW will provide learning for the National Health and Social Care Citizen Portal. Developments planned include:

• transfer of patient-recorded information transferring in to SCI-Diabetes (clearly marked as patient recorded) for sharing with the healthcare team;

• Video-linked “virtual clinics” and monthly, real-time, group “drop-in” clinics using live chat messaging, facilitated by a specialist;

• Integration with Internet of Things technologies (wearables, Smartphone apps, home monitors).

Computerised Cognitive Behavioural Therapy to treat

mild to moderate depression. Face to face CBT has been used for many years to treat mild to moderate depression. Access to digital or computerized CBT (cCBT) will enable a much larger group of people to access this clinically-proven treatment. Early trials of cCBT by NHS Forth Valley and NHS Tayside were highly successful and have shaped a Once for Scotland approach led by NHS 24 in partnership with the TEC Programme. TEC funding was given to NHS24 for CCBT in 2016. Since then it has achieved:

• cCBT services operating in all territorial health boards covering all geographical areas;

• Excess of 30,000 referrals, with over 1,250 now received per month;

• Referrals coming from 23 clinical sources; 85% from GPs;

• Patients wait no longer than 5 working days before accessing treatment;

• 77% of patients say they received the treatment they wanted and were satisfied;

• Suicide ideation of over 2,000 patients / month monitored and reported as required;

• Over 50 members of staff with expertise and skills to develop and run local services;

• A low unit treatment cost of £58 per 8 week treatment;

• 3 research publications published or submitted for publication.

There is rich learning from this successful project in terms of overcoming technical challenges, ensuring effective clinical governance, engaging clinicians, and adjusting for variability of mental health and primary care service provision across the Health Board areas. A key lesson is the time needed to develop an understanding of the environment and the people involved in implementation in each local area and to tailor the approach accordingly. The biggest influence on the time required was staff changes and their availability. Other success factors were having national expertise made available at local levels, and having a procurement model based on population, not per treatment. While the age and evidence base of the Beating the Blues product used made it easier to engage clinicians, the age of the product has made implementation affecting commencement and completion rates. Steps have been taken to replace the product at the start of 2019. That means cCBT will require additional investment in order to facilitate a smooth transition between products.


Advice and next steps The project is Developing a business case for long term funding for the licence and national elements, including an updated technical product. In order to maximise the impact of this investment in the technology it should be part of a stepped care model that will expand the use of cCBT, introduce innovations such as Online Text CBT and provide support at Tier 1 (Self-help) Levels as well as the higher tiers use of technologies such as VC. The environment in which we are deploying technology needs to be changed to make the process of implementation, testing and engaging easier to navigate with minimal variation in terms of approaches to information governance, procurement and service provision across the IJBs, Health Boards and national Boards.

Making Life Easier in North Lanarkshire

This is a unique but easy to use resource that provides a central personalised directory for health and well-being information, local services and supports across North Lanarkshire. On completion of a self-assessment, it directs individuals to local services and to relevant information and advice – for example, financial, mental health, physical health, addictions, health improvement, housing needs and carer supports. TEC investment has allowed further development of the site to identify opportunities for prevention, early intervention and adopting a self-management approach. The new and improved site was launched in September 2017 and now incorporates the Life Curve. It offers mapping and signposting to practical hints and tips, and to assessments that personalise early interventions especially in relation to active health. Making Life Easier is now embedded into the partnership strategic commissioning plan and there is a small team ensuring that the site is maintained and is up to date.

• 39% of the overall usage is out of normal working hours;

• The bounce rate is very low at 35%; • In the last year 5,500 thousand people

had just short of 9,000 sessions; • The site now supports around 700 people

per month.

Next steps A new assistive technology database of guidance notes, products, configuration forms and contacts will be transferred to the Making Life Easier professional platform for ease of access for staff. Development of an assistive technology assessment tool by December 2018. This will include capacity and consent issues as well as technical and practical considerations and will provide a tailored technology solution for each individual. Complex cases will continue to be signposted for discussion with the network of assistive technology advisors across localities.

Independent Living Angus This website launched June 2016 as an

ADL Smartcare system designed for Angus with input from local OTs for clinical content, hints, tips and decision making protocols. It aims to reduce demand on occupational therapy services for advice on minor equipment. Orders can be placed directly with the equipment store for specific pieces of equipment provided free of charge. It includes self-referral for community alarm and some peripherals.

• 4,406 unique visitors; • 190 registered users; • 1037 Assessment started;• 324 people matched with 1 or more

solutions.


5. Improvement and Support

The national improvement and support work stream brought together subject experts and created additional capacity to address the key enablers of any large scale change:

• Programme coordination; • Workforce development and education; • Engagement; • Improving processes, pathways and

interoperability; • Leadership and culture change; • Knowledge sharing; • Data and benchmarking.

Knowledge sharing is a crucial element in supporting scale up of any new or existing TEC. Over three years, the Programme hosted or contributed to over 50 learning events. These were a blend of face to face (90%) and webinar virtual meetings. Some were specific to a work stream while others were for the whole TEC Programme. Events adopt an ‘all teach all learn’ approach.

Large scale national learning events are held jointly in spring with the Scottish Telehealth and Telecare Learning Network, and as part of Scotland’s Digital Health and Care Week each November. These highly rated events attract a growing number of local and international delegates. The rich face to face knowledge exchange is supported by newsletters and online resources, for example, the National HMHM Community of Practice.

Partners identified specific supports they found valuable including:

• Signposting to peer support, advice and good practice examples;

• Learning events and networking with other partners and other sectors;

• Support for evaluation and benefits realisation;

• Opportunity to participate in the Digital Leadership Course;

• Regular calls, emails and newsletter articles of interest;


• Accessible resources on the knowledge hub;• Horizon scanning and direction on future

challenges;• Reporting and help to reflect on progress.

Many highlighted the value of shared purpose collective energy through the programme.

This has been the most supported and collaborative work stream I have worked on, and I think we can attribute most of our success to this sharing and collaborative approach. Alzheimer Scotland

Networking group and events – peer support from teams from other boards across Scotland has been invaluable and it feels like we are one big team. Angus

If one of the team didn’t know the answer right away, they were able to use their contacts and connections to assist. Their approachable attitude has really helped, as no question was a problem. East Lothian

Direction to future challenges such as digitalization. Raised profile of technology within a coherent brand/ distinct identity Glasgow HSCP

Sense of being part of an overall national programme rather than working alone Highland

The many and varied TEC events have been a real source of interest, learning and inspiration as well as great networking opportunities. There are a range of things we have heard about or seen at these events that we have brought back and put into practice. NHS Lanarkshire

Broad knowledge exchange, networking, and sector contextualisation. The wide and varied events programme (work stream specific and general) gave many learning opportunities and, importantly, time out to reflect, listen, and discuss. Midlothian HSCP

Regular monthly conference calls and monthly meetings ensured that the Project remained on track and any problems or issues were addressed and resolved. Quarriers

Tests of Change

All partners were invited to bid for a small amount of additional funding to take forward a ‘Test of Change’ to better understand how to lever TEC in delivering health and care service improvement, the barriers to adoption for new ways of working using new digital tools, and to generate evidence about what these new approaches are delivering. Each test is based on three 30 day Plan, Do, Study, Act improvement cycles and creates transferable learning about what works, and what doesn’t in using TEC to support service transformation.

Four partners were awarded a total of £65k in 2016; seven partners received a total of £72,192 in 2017; and 11 partnerships a total of £259 k in 2018 for test of change. In addition four partnerships received £144k for hypertension scale up initiatives. The examples below outline how these tests of change have been used as a catalyst for change.


Argyll & Bute tested an oncology consultation using Attend Anywhere, avoiding patient travel, and demonstrated a remote Obstetrics clinic ‘proof of concept’ with a new mum and baby in Tiree attending an Attend Anywhere remote clinic session with a Consultant Midwife and GP in Lochgilphead. Six patients receiving chemotherapy have attended weekly review clinics via Attend Anywhere instead of travelling to the hospital prior to their weekly treatment (also requiring a journey). Patient feedback has been very positive and in all cases travel has been avoided. There is an appetite to extend this approach to other Oncology services. A process manual has been adapted from the NHS Highland ‘Near Me’ work to support this.

Fig 12 Recruitment to HMHM for hypertension in Ayrshire and Arran

NHS Lothian used their funding to increase patient, carer and staff use of their Intensive Care Portal that aims to support self management and reduce readmissions. An additional 490 users over the 90 days represented a 19% increase in use of the portal. It has now been adopted by other hospitals across Scotland and had 10,000 users over 12 months.

NHS Ayrshire& Arran tested the feasibility of using Flo to remotely monitor patient’s blood pressure for diagnostic and medication titration purposes within GP practices in Ayrshire. A minimum of 3 appointments for BP monitoring were avoided per patient, equivalent to 156 appointments released over the 6 week period. Following the successful test of change the recruitment for remote BP monitoring has steadily increased as illustrated in Fig 12.


Quarriers Video Call Test of Change Changing attitudes to care delivery require additional time to help build confidence and

knowledge of new technology. In their 2017 Video Call test of change, Quarriers used additional TEC investment to explore and address the barriers to using Digital TEC. They engaged with support users, families, staff and volunteers involved in care delivery, and with statutory services commissioning care. They found that families, carers and staff alike had safety concerns about the potential removal of face to face care of their relatives or people they are supporting. They identified training needs to support for staff who may deal with people who are distressed via a call or video session. They then put together information resources with support and material provided by the Scottish Fire and Rescue Service and NHS24, based on their experience of call handling when staff are under stress with clients at risk. Finally, they delivered training and support to 39 stakeholders who are using the video call system as part of their support or to provide support. Confidence levels increased after training and service users, staff and their families are now using or considering use of Digital TEC in daily support or in the redesign of overnight support. The tablets that were provided have been distributed within Quarriers with various apps so the people that Quarriers support can continue to video call friends and family and use a calendar system as well as use social apps. The Digital Inclusion Team continues to run the Go4it Clubs in Quarriers Village, East Ayrshire and North Lanarkshire. They are able to provide support and advice on the use of technologies which could improve the lives of the people Quarriers support and or enable them to self-manage aspects of their care. Digital TEC is offered as part of their support if they choose and Quarriers will support their purchase or source funding for ‘off the shelf’ products such as ‘Amazon Show’, ‘ Alexa’, ‘Google Home’, Eye Gaze equipment, alarms, sensors and epilepsy monitors. Staff are more aware of the use of Digital Telecare and, for example, have recently sourced individual funding for pieces of equipment such as the EMBRACE epilepsy wrist watch and other personal alert systems to enable greater independence. Quarriers continue to participate in TEC assessments as part of overnight support provision and are still able to provide the responder solution as requested by South Ayrshire HSCP in our Girvan Service.

Baseline Questionaire: Do you feel confident using the video call function?

Not very confident A little bit confident Very confident

Post Training Questionaire: How confident are you about using the video calling system

Not very confident A little confident Very confident

42%

16%

26% 58%

32% 26%


Workforce development

Workforce development and capability are acknowledged as a key enabler of the culture change required to transform care. Sustainable support is required to develop the right knowledge, skills, confidence and a workforce culture that is ready and able to adopt technology enabled care and use digital ways of across health and care.

The TEC Programme commissioned NHS Education for Scotland (NES) to undertake national research to help understand current and future workforce development requirements. Figure 13 shows the response to a survey by 635 individuals from a range of disciplines. Only 2% of respondents reported no interest in using TEC.

The report Supporting Scotland’s Workforce published in 2017 has prompted work by NES to develop online learning modules and a series of action research workforce stories. These learning modules are being developed with the health, care, housing, and third sector workforce and in collaboration with the Scottish Social Services Council, academia, the Scottish Fire and Rescue Service, and Alzheimer Scotland. The learning resources are hosted within NES Turas Learn platform. The Digital Health and Care Learning and Support Resource aims to

become the national one-stop-shop for learning and practice support resources for the health and care workforce in Scotland. The action research workforce stories will be presented as a range of AV and written materials that illustrate how different staff use TEC and the difference this has made in their roles. This work draws on the links with the NES Digital Health Leadership Programme. Since January 2018, nine non-clinical TEC Leads have commenced this programme.

Workforce development is at the heart of the TEC collaboration with Scottish Fire and Rescue Service (SFRS). SFRS staff are trained on identifying falls risk and awareness of Telecare solutions. Some areas have joint posts. For example, in South Ayrshire, a SFRS staff member installing a smoke detector offered a fire safety visit and immediately identified burn marks on the service user’s bedding. She offered fire resistant bedding and advice and placed an additional smoke detector in the bedroom and the hall reducing fire risks.

Engagement

TEC has engaged widely across sectors, involving specific care groups, professionals, users, carers and the general public to raise awareness and create a shift in culture.

Fig 13 Respondents to national workforce survey on TEC – source NES report


Dementia

From the outset, the TEC Programme aimed to raise awareness of how everyday technology can improve the lives of people living with dementia in Scotland. Awareness raising has been achieved through a partnership with Alzheimer Scotland and links to programmes with other organisations such as Scottish Fire and Rescue Service, NHS24, NES, the Scottish Ambulance Service, community safety, dementia friendly communities, academic partners, Carers UK, industry and innovators. This approach to engagement created a successful collaborative Dementia and Technology Thinking Space.

With TEC funding and support, the Alzheimer Scotland TEC team developed the 2015 Technology Charter for People with Dementia in Scotland. Since then the collaboration has supported a number of initiatives that breathe life into the Charter.

• Developed the Dementia Circle platform content and video;

• Devised and delivered Confident; conversations training for over 1000 people;

• Built relationships with manufacturers and commissioners of TEC products;

• Tested products with people living with dementia;

• Promoted Tech Tuesday conversations on Twitter Feed #dementiahacks;

• Developed national good practice for Missing Persons with Dementia;

• Developed Safer Walking educational materials;

• Developed and supported adoption of Purple alert.

Housing

The TEC Programme granted funding to the Scottish Federation of Housing Associations (SFHA) to lead engagement with the housing sector. Recruitment of project support and leadership changes within SFHA resulted in some delays but the main achievements are:

• Increasing awareness amongst housing organisations on the relevance of TEC Work with Aberdeen City Council and local housing providers generated 95 referrals from housing staff. Care and Repair now use the TEC screening tool as part of their assessment process and follow up with referrals and requests for joint assessments;

• Increasing participation of the housing sector in TEC learning events. More than 100 people attended the recent event organised by SFHA;

• Technology Enabled Care in Housing website with examples of how the sector is using TEC to improve outcomes for people across the life stages, and for their carers. Case studies include Blackwood’s CleverCogs, Wheatley Group, Hanover, and Castle Rock Edinvar;

• Encouraging colleagues to take the next steps towards a digital future. Linstone Housing training and use of Digital Tec in Renfrewshire https://www.youtube.com/watch?v=L0i4Ep_VQww&feature=youtu.be;

• Participation in the A2D transformation programme and in opportunities to lever innovation funding.

Purple Alert is a free app designed by people living with dementia and carers, Alzheimer Scotland staff, Police

Scotland, Social Work, Dementia Friends Scotland, Health and Social Care Partnerships and telecare services. The app harnesses the power of communities to respond in the event of people with dementia losing their way. After 18 months of development the app was tested live in staged missing persons events held in Tain, Edinburgh and Glasgow, with carers and the local communities engaged in the search. The experience informed refinement of the version that was launched in 2017.


Albyn Housing Society is testing a fully digital approach to incident and activity

monitoring at home within a new development of digitally enabled ‘Fit Homes’. Between July 2017 – July 2018 they:

• identified and contracted a new technology partner (Rapport Networks);

• evaluated and selected off-the-shelf sensor devices;

• linked these to a secure database; • developed a prototype user dashboard;• evaluated and selected an appropriate

broadband package for the premises;• installed and tested the solution in an

empty Fit Home;• identified Fit Home tenants to take part in

live testing and began testing the solution with them.

The project is a collaboration between Albyn, NHS Highland, Carbon Dynamic who share a common vision. Other financial support is from the Digital Health & Care Institute and The Data Lab to work with artificial intelligence experts at Robert Gordon University to explore how monitoring data might be used to predict changes in health. Further support has been secured from the Inverness City-Region Deal, the Social Innovation Fund and The Data Lab as well as in-kind support from a wide range of organisations including Censis, Ignite, Highlands and Islands Enterprise and Openreach. ‘’Initial feedback from tenants has been very positive – that we are investing in a new solution to help them in this way, that they already feel safer, that they quickly forgot that the sensors were there, and that they see the potential for how the data generated might be able to help them.’’

Leadership and Culture Change

Influencing the attitudes, beliefs and practices of professionals is a continuing challenge when introducing any change programme. Some partnerships have some interesting learning to share on their approach to winning hearts and minds and helping people to ‘Think differently’ about a TEC and digital future.

East Ayrshire Council “Thinking Differently” is promoting Self Directed

Support, SMART Supports and Carers Support under the one agenda. The TEC Stakeholder Group and Self Directed Support Programme Board worked together to develop a Thinking Differently Team aligned to a single management contact and peer mentor model across the partnership. This is a sustainable model post conclusion of TEC (and SDS) programme resources. The Thinking Differently Team Peer Mentor model approach allows a better understanding of staff learning needs to inform how best to promote TEC. On-site coaching and a critical friend approach has been crucial in building confidence, promoting an asset based approach, challenging risk averse practice and “thinking differently” across the Partnership. A dedicated Smart Supports Team demonstrates a long term commitment to TEC with assessments embedded as part of social care assessments.

West Dunbartonshire The HMHM work stream utilised Florence

which was easily accepted by the NHS staff who were working with the COPD patients –the challenge was much greater within our frailty project where a much larger cohort of both health & social care staff needed to be on board. Probably our biggest achievement was the success we achieved in encouraging these staff to think about using TEC as an option to support vulnerable people. We faced a lot of uneasiness at first especially around the use of Canary or the GPS systems where it was felt to be an invasion of privacy. However as their experience grew that became less so. Although this was a success it is still a work in progress.


Culture change, engagement and leadership are closely linked. The TEC Programme has encouraged senior leadership as a mechanism to promote local ownership and plans for sustainability.

TEC funding has enabled TEC to be considered in a more strategic and integrated way than before. Gaining buy in from our strategic leadership team to support our TEC exit strategy enabling us to relaunch TEC as a centrally managed service that will continue after the TEC Programme. The TEC service will move forward aligned to HSCP strategic priorities.Argyll and Bute HSCP

Established TEC as an integral part of the HSCP’s portfolio and a keenness from our senior management to sustain the service beyond the programme. East Renfrewshire HSCP

Improving Processes, Pathways and Interoperability

Aberdeen HSCP employed two dedicated OT’s to raise awareness of

telecare, improve referral processes and deliver training to a wide range of professionals and the public. 2347 people have participated in competency-based training and information leaflets and posters are widely displayed. Over the project, 1674 people have been screened using a simple screening tool and referrals from hospitals increased from 96 per year to an average of 352 each year. The tool is embedded in paperwork used by housing and care and repair staff and in respite / intermediate care. Six demonstrator wards were set up across two acute hospitals and the Psychiatric Hospital and staff trained to use the telecare equipment installed. This has reduced the need for 1:1 supervision of some patients.

TelecareKeeping you safe at homePeace of mind and reassurance for you and your family

Equipment:Alarm pendant (fall detector)/Epilepsy /Smoke detector/Door sensors/GPS device/Automatic monitoring

• Telecare is an adaptable range of technology used in the home to help you to live independently, safely and with confidence

• For ANYONE of ANY age following an individual assessment

• Can link with smartphones

• Can be available as soon as you come home from hospital

• Reassures you and your family that help can be called at anytime

• Monitoring of equipment can be by a family member or a 24 hour monitoring centre

What is Telecare?

Bon Accord Telecare Team

• Dedicated team of professionals with expert knowledge of Telecare

• We work with you to ensure you receive the appropriate equipment and response

• We install and maintain equipment

• We can devise individual solutions tailored to meet your needs

• There is a nominal charge for this service

How to access TELECARE

Your doctor, care manager, occupational therapist, nurse or other health professional can refer you for an assessment for Telecare.Alternatively YOU can contact the service direct to discuss your requirements.

Contact details:Bon Accord Care Telecare ServiceCommunity Equipment StoreUnits 3-4 Whitemyres AvenueAberdeenAB16 6HQTel: 01224 788616

3,000 people in Aberdeen

are supported to live in their

own home with Telecare

Dementia“It gives us great peace of mind knowing we will be alerted if mum leaves the house during the night”

Elderly and Frail“Telecare saved my life”

Children and young people“I felt great when mum and dad had a night out - safe in the knowledge I could get help through Telecare”

Falls“I dread to think how long I would have been on the floor had I not been wearing a fall detector”

Vulnerable and learning disability“Without Telecare I would still be living in hospital - I now have my own home and independence”

bon accordcare in Aberdeen

Enabling you to return home from hospital earlier

Fall detector

Automatic pill dispenser

Epilepsy sensor

Community alarm

Pendant


South Ayrshire HSCP are able to process and update their systems using remote access to PNC7 through the service manager giving real time responses to support hospital discharge and vulnerable individuals in the community, including at end of life. They introduced TEC in the post diagnostic dementia pathway and service users increased from 900 to 3000 over the programme. In a partnership with SFRS, all service users have a smoke detector as part of their Telecare package.

East Renfrewshire HSCP provides a Telecare alarm as a standard component of a hospital discharge care package, free of charge for the first 6 weeks to support early discharge and promote the benefits of TEC. This is a same /next day install to support people as soon as they are discharged from hospital and provide the associated reassurance to families and carers. There has been a high take up and low cancellation rate after the 6 week trial rate. The HSCP view is that benefits to residents and ’services’ far outweigh the lost income cost

North Highland developed an Electronic Asset Management System for Telecare in

the Community to build services safely and securely as they switch from analogue to digital. A joint initiative with NHSH Community Equipment Stores (North), it delivered a robust asset management system able to locate, track and manage all 11,000 telecare assets for around 2,500 Telecare clients in an area of 25,657km². They introduced ELMS2 to track and maintain assets and installations. Installers have handheld devices to scan the serial numbers from the telecare equipment which updates the electronic database in real time, eliminating transcription error. From January 2017 ELMS2 ensures all asset information is live and in real time and schedules annual health checks geographically. This enables budgeting and identifying replacements where warranty dates are approaching or lapsed. Clients advise that they feel more confident in using Telecare as each year a Handyperson Services/Care and Repair staff member checks the equipment and remind clients how it works. Both internal Telecare staff and externally contracted installers say this is a much easier and efficient process and provides a solid foundation for expansion and A2DT.

TEC Hubs and Resource Centres

Many organisations have developed TEC training suites for staff, the public and offer TEC advice and support for users and carers.

In 2015, East Ayrshire HSCP and CVO partners created WG13, a community

café and digital hub in central Kilmarnock. It offers peer support and tutorials for using TEC, ICT and social media and has a mock home environment allowing people to experience how interactive TEC could support them at home. It offers a drop-in and a Connect Call – Telephone Befriending Service, with plans to implement VC facilities. It also provides public information leaflets about SMART Supports to raise awareness of TEC as an early intervention solution and hosts two Epilepsy Support Groups for 35 people, 20 of whom use TEC to increase independence, reduce isolation whilst keeping safe.


A telecare demonstration room opened in Kirriemuir community hub, Angus

HSCP in Feb 2018. KirrieConnections is the base for Dementia Friendly Kirriemuir in collaboration with Alzheimer Scotland and the Angus Carers Centre. KirrieConnections are keen to expand the range of telecare that they display and have signed up to the Digital Participation Charter. ‘’If we can make individuals aware of the support that is available for them going forward they will be more prepared and more resilient for what is to come.” K Connections Manager “Fantastic Facility” CM, Carer “Lots of great information” PM, Carer

Clacks and Stirling HSCP developed TEC Demonstration spaces in 4

premises across the partnership. These have a range of Telecare equipment provided by the service along with additional simple equipment which can be purchased on the high street to support health and well being at home. Events allow staff, the public, service users and partners to see telecare solutions in action.

East Renfrewshire’s Building Safer Communities partnership with the Fire

Service offers linked smoke detection and home fire safety advice, and works with the local Prevention team to reduce nuisance scam calls and doorstep crime. Interactive sessions in the TEC demo room and a ‘lend and trial’ initiative allows individuals and local care home staff to try out technology and learn how to get on line. Staff use tablets with information about TEC and links to useful online health and wellbeing information during conversations with service users. To learn more about their approach watch these short videos: Technology Enabled Care (TEC) – East Renfrewshire Council and TEC – A Social Worker’s story


Two key enablers of local progress were evident in all responses: the TEC Programme and improvement support, and access to funding for additional capacity for TEC.

Strong, friendly and encouraging support and assistance from the TEC Programme including the Programme Management Office team. East Renfrewshire

In the early stages of our work we had really clear guidance and strategic support…. not only helped us shape our work in the national context of the funding, but linked us with other tech partners and facilitated introductions across the country which secured lasting partnerships across the length of the funding period. Alzheimer Scotland

Access to a network of colleagues and peers,…….allowed us to build our contacts and share learning with other partnerships, and to meet and develop links with a far wider range of suppliers. Perth & Kinross

Funding to recruit a TEC Project Lead enabled us to have a dedicated resource for the promotion, awareness raising and front line engagement with staff and services as well as providing first line support for any issues with TEC equipment and systems. Dumfries & Galloway

Having funding to increase our capacity in terms of a project manager and marketing/training officer hugely helped us move forward and gave us a renewed vigour to drive TEC and make a difference locally. Inverclyde

Communication, a co-production approach and leadership were all considered important. Some partners developed audio video materials with support from local champions. Communication was considered to be an ongoing challenge because of staff turnover.

Very enthusiastic communications manager who kept successes in the news/social media whenever possible. NHS Lanarkshire

Publicity both internal and external – sharing success and creating demand. Western Isles

Continuous “advertising” – reminding staff about the availability of the equipment and what it could do. The videos we produced helped with this. West Dunbartonshire

Individuals with lived life experiences have been essential in the design, delivery and ongoing improvements made to Making Life Easier North Lanarkshire

Carebuilder’ software with people we support, older people, staff and families. Quarriers

Listening and learning from clinicians and service users. NHS Lothian

Having our Tec team led by Service planning with a head of service giving leadership at all levels worked very well and maintained the focus. Argyll & Bute

A ‘digital by design ’strategy at Council level lending weight to our messages of the benefits and opportunities brought by technology and digital thinking. East Renfrewshire

Appointment of TEC Clinical Lead to engage with GP practices, trusted and respected helped to ‘open doors’ with those GP Practices not yet embracing TEC. TEC champions within the early adopting practices. Ayrshire & Arran

Enabling Progress


Enthusiasm within areas of the Housing sector to integrate digital technology across the spectrum of inclusion, prevention and wellbeing. SFHA

Access to local technical expertise was highly valued. Some areas collaborated, for example, Lanarkshire and Ayrshire worked together to obtain BP monitors at the best possible price.

A dedicated and enthusiastic TEC and Innovation team – providing expertise and support to services during the design, test and implementation phases, and trouble-shoot any issues. Working closely with Head of Information Governance to ensure compliance when introducing new systems and protocols. Ayrshire & Arran

The support of our IT/e health colleagues in NHS and the partner agencies to enable this to proceed and support and guidance from NHSL data analyst and evaluation staff enabled us to demonstrate key successes both locally and nationally. NHS Lanarkshire

Working alongside Telecare team who are well established – able to tap into their knowledge and network. East Lothian HSCP

Wider system redesign and constraints were challenging yet also presented opportunities, particularly where partners responded with innovation, courage and resilience.

Wider policy and budget constraints has made the use of TEC much more systematic and a recognition that it is a catalyst that contributes to cost effective and efficient reconfigured care arrangements. Glasgow HSCP

NHSL the inclusion of VC within strategic plans including the new Monkland’s hospital and modern outpatients programmes. NHS Lanarkshire

The enthusiasm and commitment of all partners for the duration of 3 years from start to completion despite drawbacks and stumbling points. Angus HSCP

Brave and innovative TEC team. Hard work, determination, patience. ‘You win some, you lose some’ approach. Western Isles

Resilience in the face of adversity and set-backs along the way. East Renfrewshire HSCP


Pulling it all together in West Lothian

The TEC Programme has both challenged and supported partners to develop a strategic and sustainable approach. The example from West Lothian reflects how they have drawn on the full range of TEC funding and supports to benefit their citizens.

The formation of the West Lothian TEC Board has been an example of a truly integrated team that facilitated a culture of co-operation and coordination between primary,

secondary and social care. Maximising the use of TEC features in the following strategies:

• WL IJB Strategic Plan 2016-26;• WL Transforming your Council: Corporate Plan 2018/19 to 2022/23;• WL Digital Transformation Strategy 2018/19 to 2022/23;• WL Primary Care Development Programme;• WL Social Policy Management Plan 2018/19.

Ability to test products and identify the benefits of embedding such technology in wider packages of care e.g. activity monitoring. Ability to prove that technology can radically transform the way we deliver healthcare by enabling service users/patients to take a more active role in their own health and increase prevention through supported self-care e.g. myCOPD.

Opportunities for collaboration with and support provided from partners at a national, regional and local level and the inspiration to maintain momentum. Participation on the ARC programme helped give us the confidence that plans in West Lothian are compatible with counterparts across Europe.

Supporting health and care professionals to make the best use of data and technology and develop knowledge and skills to embrace information opportunities e.g. activity monitoring (multi-user)

Assuring best value for taxpayers by encouraging the use of technologies that reduce the cost and improve the value of health and social care delivery. Ability to prove that age is not a barrier to the introduction of TEC and dispel the myths surrounding the elderly and digital ability.

Management support for the TEC team has been fundamental to progress. The dedicated TEC Team have developed a wealth of knowledge and experience; they have taken ‘roadshows’ to raise awareness of TEC potential across teams in health and social care and will support implementation of projects. We have plans to extend this knowledge across staff in the Home Safety Service.

Technology has become integral to service redesign – e.g. TEC specialist included in the new Single Point of Access Team recently introduced and as part of the assessment process. We are gradually chipping away at resistance from staff, service users and carers by increasing the TEC offers available locally. The local TEC facility is gathering momentum and enquiries are being channeled through the Board for consideration and advice.

Interoperability issues continue to hamper progress and will be resolved when the A2D 200 Hub & Cluster project provides the evidence for the options for Alarm Receiving Centre.


The most common frustrations reported by partners related to various system constraints, upgrades and changes, limited utility of some websites, and limited infrastructure and broadband connectivity in some areas. These were generally issues over which they perceived they had little influence. A number of TEC partners reported that some suppliers were slow to respond to requests for increased functionality and interoperability. Some challenges were local system issues associated with older hardware in GP practices.

An important practical problem was that the finance available for investment was generally ring fenced to meet agreed objectives within the TEC delivery plan leaving little resource available to upgrade systems to meet any changes in local data governance agreements.

Local procurement systems often struggled with a model of granting / loaning assets across services as assets are generally owned and managed by the specific purchasing services.

The next most frequent challenges related to recruitment to short term, fixed posts; and staff retention and turnover.

Staffing pressures in acute sector have made engagement very difficult – staff groups are consistently changing, and it is extremely difficult to get any consistency. All the members of the original project group moved on or retired within the first year and it was very difficult to get new people to engage with the project. Aberdeen HSCP

Recruitment and retention to short fixed term posts. We struggled to get a full team in place and when we did we had problems with staff absences. Argyll & Bute HSCP

Difficulties in staff recruitment and retention, partially due to short term contracts. NHS Highland

This meant that, for some, their initial targets were overambitious and timescales and trajectories had to be reviewed. Views differed on the TEC Programme reporting.

Emphasis on targets and provision of HMHM “at scale” from a standing start – to incorporate Service redesign in three years. The first 3 years have been mainly about the use of technology. Highland

There was a High volume of reporting, difficulty getting our finance team to have reports ready as their reporting periods did not align with the TEC Programme. Not all the stats requested are easily available. Argyll & Bute HSCP

Reporting reminders and flexibility showed – eg allowing delivery dates to be renegotiated where appropriately justified. Reporting format allowed a good record of progress to be maintained and encouraged forward planning. East Renfrewshire HSCP

An important theme was the challenge of influencing culture and behaviours. This issue was common across TEC partners and across disciplines and care groups. However, because of the primary care focus for HMHM, GPs were acknowledged to have a central role in any efforts to scale up TEC. In all areas, securing GP buy in still requires more attention.

Limited health sector buy-in, resource restrictions and a lack of support infrastructure has led to a disappointing piecemeal, small-scale roll out of HMHM to date. Take up has tended to be clinician led, based on word of mouth. Glasgow HSCP

A fair bit of scepticism from clinicians and a fear of how it would impact on their role Argyll& Bute

What didn’t work so well


Clinical engagement. Ultimately, clinicians are the people that provide the services and if they don’t want to change their existing processes, progress will be held back. Dumfries & Galloway

The number of GPs using Flo and realising the benefits of Remote Patient Monitoring (RPM) has been lower than anticipated. Governance and responsibility seems to be their main concerns. Some clinicians within services still have some mistrust of TEC solutions and prefer to maintain more face-to-face consultations. Angus HSCP

There is more resistance to adopting new technologies due to a number of factors; integration with NHS systems, Clinical Governance concerns, capacity to take on anything new, and a resistance to change current ways of doing things. Perth & Kinross HSCP

These issues are also evident for Third sector, housing and social sector partners.

We did under estimate how much of a cultural change it would be to embed digital within practice, we also over estimated professional competency around the use of digital and being able to translate personal use into a

professional landscape. There were pockets of resistance sometimes in places where you just wouldn’t have expected to have met this, and in other areas particularly in our work with carers where we were overwhelmed with their acceptance and willingness to adopt solutions. Although we have over delivered in our learning events we have been disappointed in the uptake of badges, but we will continue to work on this. Alzheimer Scotland

Initially staff were very resistant as they almost felt that they were being ‘replaced’ and there was a threat to their hours of work and sleepover hours. Staff were therefore on occasions reluctant to use to use the mobile app and the TEC equipment. Quarriers

TEC partners stressed the long timescale required to make the culture shift.

Changing culture takes time and demand for peer mentor support has increased, continuous support is required to keep the workforce, new staff up to date with TEC and have the confidence to think TEC first. We have recognised that without continuous support to “think TEC first” it can lose momentum. East Ayrshire HSCP


From the outset, partners have been encouraged to consider how to embed and sustain their TEC funded initiatives, making the links with their IJB Strategic Plans and other policy initiatives, and levering additional investment as appropriate across all sectors. TEC partners reflected to what extent their initiatives are ready to be mainstreamed.

The Telecare work stream has the greatest level of maturity, building on a strong evidence base from a decade of learning since the initial Telecare Development Programme, and the recent feasibility study by Deloitte. However there is considerable work ahead to prepare for the switch from analogue to digital telecare and to make best use of enhanced telecare in redesigned pathways in localities.

Ongoing TEC service funding secured and in our Quality and finance plan enabling our TEC service to continue to embed and meet strategic priorities. The HMHM priorities will now be reviewed to ensure it is focused on key areas within our strategic plan. The Telecare part of the TEC service has been reviewed and is now very focused on supporting a more efficient use of resources going forward. Central management of the entire TEC service now sits fully within the service planning department. Further work to be carried out by TEC staff to ensure TEC within new emerging neighbourhood teams and local pathways. Argyll & Bute HSCP

TEC is very much embedded in our everyday service. We continue to receive funding from integrated care monies which allows us to continue to improve on the numbers of citizens we help and services we work closely with. The GPS pilot still continues and we have used ICF funding to increase the numbers of local people using this technology. Inverclyde HSCP

Our board has approved the integration of the three posts funded by TEC funding to be sustained after the funding period. This will enable us to further our internal and external ambitions, further develop our learning programmes, and embed our digital strategy work across our organisation. We will work to ensure the commitments 11 and 16 in the dementia strategy are actioned and deliver on our partnership work in the citizen technology agenda. Alzheimer Scotland

More recent developments have still to be evaluated

We are currently evaluating our use of the ILA system and will conclude our future requirement for this type of service. Angus HSCP

Extensive evaluation activity, so evidence for the effectiveness of HMHM is available. Production of SBARs and Business Cases, submitted to Chief Officer NHS Highland

Sustainability has been promoted by including TEC in workforce induction and through co-design of protocols and pathways to promote ownership and ongoing commitment.

All our recruitment includes the use of technology enabled care as part of the support that staff will be providing. Quarriers

Where applicable, designing the model correctly from the outset (eg for HMHM it is a GP owned model, respecting the patient- practitioner dynamic) East Renfrewshire HSCP

Work is ongoing at present to embed the service in the Community Front Door Model for the HSCP to continue to support individuals in a joined up/ co –produced manner with other professions to get the right assessment at the right time by a skilled person. Pathways will

Embedding and Sustaining TEC


continue to be developed by the Technology ENABLED Care Teams across the HSCP to ensure all opportunities for people to have access to TEC remain available. The service is involved in the Integrated Discharge Service to ensure TEC is considered for all appropriate hospital discharges. Clacks & Stirling HSCP

Some partners are bringing together their work on TEC, long term conditions, Innovation and Digital services in line with the direction of the new Digital Health and Care Strategy.

The Senior Management Team has adopted a “digital by default” approach, where technology can be used, it should be used as the first option. This principle will be included in our own digital health and care strategy (in development) which once published will be incorporated within our updated Service Planning Framework. The HSCP has appointed a Digital Health & Long term conditions Commissioner within Strategic Planning indicating the priority for scaling up and adopting digital technology into business as usual practices. The TEC Project Lead post is being turned into a permanent position. We are beginning the development of a local Digital Health and Care Strategy to ensure we have the strategic framework in place for ensuring that the recommendations from the national strategy are delivered. Dumfries & Galloway

The TEC and Innovation team have moved under the umbrella of Digital Services and is now known as Ayrshire and Arran TEC and Innovation within Digital Services. NHS Ayrshire and Arran

All four TEC team posts were made substantive in July 2018 which cover all TEC work streams. A business case is being developed to ensure this programme can be supported with adequate resources to meet the National and Local Digital Health and Care strategic delivery plans. Senior strategic management in Lanarkshire has endorsed the value of sustaining this programme and inclusion in strategic plans. NHS Lanarkshire

TEC lead is now a permanent post as part of Long Term Conditions Project Manager remit. We are now devolving the system into the 4 Lothian HSCPs with the help of Telehealth Project Assistants. A reference group to be formed to support the development of a Local Digital Strategy and Action Plan. NHS Lothian

We have developed and presented our TEC strategy to our Integrated Joint Board and had it endorsed. TEC is seen as an integral driver of performance across Health and Social care within our partnership, and links with Housing are also well established. Perth & Kinross HSCP


Going forward, all TEC Programme activity will be progressed under the auspices of the Digital Health and Care Strategy. Published in April 2018, the Strategy describes how digital can support our vision for health and care whereby, as a citizen of Scotland:

‘I have access to the digital information, tools and services I need to help maintain and improve my health and wellbeing. I expect my health and social care information to be captured electronically, integrated and shared securely to assist service staff and carers that need to see it …and that digital technology and data will be used appropriately and innovatively:

• to help plan and improve health and care services;

• enable research and economic development;

• and ultimately improve outcomes for everyone.’

The Strategy was informed by two key reports, both of which covered the TEC Programme. The Scottish Parliament’s Health & Sport Committee held an enquiry into ‘Technology & Innovation in Health & Social Care’, during which the Committee heard general support for the TEC Programme (particularly around its focus on providing resources for evidence-based interventions and on developing the support infrastructure to implement successful, evidence-based digital solutions at scale). The Committee’s resultant report applauded initiatives such as developments in telehealth/telecare, video-conferencing and virtual clinics. The report did, however, note that the spread

of such approaches should be accelerated, and noted that many submissions were supportive of the TEC Programme with some specific examples cited. It also sets out a number of recommendations including the opportunity for person centred approaches, the need for a national ‘once for Scotland’ approach, requirement to support scale up and adoption of evidence-based technologies, and addressing cultural barriers to encourage widespread acceptance and uptake of technology and innovation.

This report was augmented by a specially commissioned External Expert report into Digital Health & Care in Scotland. This report concluded that whilst Scotland is already a world leader in utilising technology enabled care, much more should be done, which chimes with the Health & Sport Committee’s finding. Their main recommendation was that “evidence-based technology enabled care…be more broadly implemented at scale across Scotland”:

• Evidence-based technology enabled health and care (TEC, including telehealth), be more broadly implemented at scale across Scotland, supporting people to live well, safely at home and support self-management, building on work already underway on next generation telecare and telehealth;

• Initial use cases should include care and management of common chronic conditions such as diabetes and hypertension; building upon the substantial success of these latter two which is already starting to emerge across the country;

• Another use case will be delivery of care for urgent health and care needs outside the hospital.

Gearing up for Digital Health and Care


The Digital Health & Care Strategy accordingly recognises that TEC has made ‘important strides to empower individuals to live more independently and manage their own care at home, as well as helping us to develop evidence-based approaches to scaling up as part of service design.’ The Strategy commits to “empower citizens to better manage their health & wellbeing, support independent living and gain access to services through digital means. We know this is leading to a shift in the balance of care by using the tools and technologies that

we are already increasingly using for all other aspects of our lives.” An entire focus area – or ‘Domain’ – is dedicated to accelerating the scale up of TEC-related initiatives through a broader approach to ‘Service Transformation’, whereby spread and adoption of proven digital technologies within services is recognised as critical to the success of the Strategy. In line with the timings in the Strategy, the approach to how we support further scale up will be implemented from April 2019.


TEC partners were invited to indicate the future support they would welcome in the context of the Digital Health and Care Strategy. The list below represents the most frequent asks:

Funding

Further funding to continue the work – we have started to make real progress in year 3. It would be good to have a Year 4 and 5. NHS Highland

Ability to apply for further TEC funding for local initiatives towards the national Digital Strategy. East Renfrewshire

Webinars, learning events, peer support and networking If something works, there shouldn’t be the desire/need to ‘pilot’ it in our area so real push on sharing the learning from successful approaches established by other areas in the form of tool kits – e.g. NHS Near Me in Highland. Dumfries & Galloway

We always return from any national collaborative meeting with new ideas to try and to consider their implementation locally –we would not be able to do this without the national infrastructure in place. West Lothian

Linking it all up

Linking up the national emerging work on national platforms, patient portals to ensure it links with local digital developments and HMHM and digital Telecare. SFHA

Communication – messages on value of TEC and digital in all policies and support to improve clinician engagement and integration with ehealth

Support to secure HMHM commitment at a strategic level from eHealth so remote patient monitoring is perceived and supported as a future solution for health and social care across the board with the aim that this commitment filters down to local level. Continued co-ordination to provide continuity to a joint effort to promote and embed RPM across Scotland. Argyll & Bute

National “Once for Scotland” solutions – eg supplier engagement and market facilitation to produce what TEC leads want in terms of product range, usability and reliability; national procurement frameworks;

I feel having access to TEC “experts” who could help us identify what kind of TEC would suit our patients/clients needs would be beneficial. This is a rapidly changing area and it is difficult to keep in touch with new developments. Also having nationally procured systems that we could tap into would be ideal. West Dunbartonshire HSCP

A2DT leadership, and lessons from Wave 1 and 2 Test of Change.

The move from anologue to digital will have to be approached as a business case and will need corporate support to fund. South Ayrshire HSCP

Future national support


Support for analysis and use of data and design of evaluation studies

Not all partners are as confident as the West Lothian TEC team who have much experience and history in this field. Other teams would welcome support for analysis and evaluation

We have gained skills and experience in overseeing and scrutinising local TEC implementation plans, asking the right TEC questions, seeking assurances, determining quality requirements, providing focused advice and guidance on the management of projects, identifying risk and ensure effective evaluation. West Lothian

Third sector and housing sector partners had some specific requests for future support.

We would greatly appreciate opportunities to work to embed dementia within the digital heath and care strategy, we would like to get dementia included in the strategy, and be considered as a key strategic partner in future work. Alzheimer Scotland

Competent and complete Broadband Infrastructure nationwide. Quarriers

Other support requested

• Continuation of a nationally co-ordinated VC / AA action group;

• National approach to Information and Clinical Governance and Caldicott;

• Support on digital inclusion and to digitally enable local teams;

• Development and testing of new technologies to meet the digital challenge;

• Streamline information access and reporting, particularly for mobile workers;

• Ensure national, local and international programmes are in line with each other;

• Formal qualifications for staff involved in TEC.

The response from Midlothian HSCP TEC team outlines the complexity of the current landscape and the support the partnership would value as they prepare to embrace a digital future.

Scottish Federation of Housing Associations A nationally funded drive to ‘join the dots’ between Health, Housing and Social Care. A link to strategic planning, recognising what joins health, housing and social care

• Place;• Neighbourhood;• Digital and digital inclusion;• Raising the profile of the Digital Health

and Care Institute across housing sector;• Bringing together all the work being

undertaken across the housing sector with the HMHM work, to recognise the potential for use of own technology;

• More emphasis around Self-management and prevention agenda;

• Digital Coaching;• Use of digital technology in service

redesign within Housing sector;• Focus on socialisation / loneliness /

inclusion.


Midlothian HSCP Infrastructure guidance – this is coming but is a crucial area as we redesign not just what we do but what we enable for the future (e.g. patient held records/data, IHE, ‘health’ information not just sickness information for monitoring, breaking data silos, ID management, authentication). There are a number of groups that are working on this (DHI, NDS, LDGO, Digital Platform work stream in TEC). It will be increasingly important to make or influence strategic decisions within the partnership aligned to the emerging new digital model. TEC Leads / Digital Health & Social Care Transformation Managers need to be aware of where the opportunities are to engage in ‘once for Scotland’ innovation, where we need to stretch for the future, and where we need to sit tight. We need to blend TEC with traditional IM&T approaches to deliver the future. Cybersecurity –as we ‘go digital’ in Scotland this is going to be a bigger and bigger issue. There are issues around organisational funding to be addressed locally (i.e. IT needs investment to be safe) but in the wider sense having a working understanding of the implications of a digital approach (so you can go armed to meetings with the right questions) and have an awareness of the pertinent issues would be helpful.

Business Intelligence & Analytics / Informatics – supporting automation of data returns through the national programme that can be linked to other datasets.


Digital Health and Care Strategy 2017-2022https://www.digihealthcare.scot/home/strategy/

Digital Health and Care Expert Panel Reporthttps://www.gov.scot/publications/digital-health-care-scotland-report-external-expert-panel/

National Clinical Strategyhttps://www2.gov.scot/Resource/0049/00494144.pdf

Health and Social Care Delivery Planhttps://www.gov.scot/publications/health-social-care-delivery-plan/

SG 2020 Visionhttps://www2.gov.scot/Topics/Health/Policy/2020-Vision

National Telehealth and Telecare Delivery Plan to 2016https://www2.gov.scot/Publications/2012/12/7791

TEC Delivery Plan for 2018 – 19https://www.digihealthcare.scot/home/resources/technology-enabled-care-tec/

Supporting & Empowering Scotland’s Citizens: National Action Plan for Technology Enabled Carehttps://www.gov.scot/publications/supporting-empowering-scotlands-citizens-national-action-plan-technology-enabled-care/

TEC Programme Data Review and Evaluation: Summary Reporthttps://www.gov.scot/publications/technology-enabled-care-programme-data-review-evaluation-options-study-summary/

Readiness self-assessment checklisthttp://www.telemedicine-momentum.eu/18-factors/

Scottish Centre for Telehealth and Telecare Activityhttps://sctt.org.uk/programmes/telecare/

National HMHM Community of Practicehttps://sctt.org.uk/programmes/home-and-mobile-monitoring/community-of-practice-2/hmhm-transformation-in-action/

National Home and Mobile Health Monitoring Service Modelhttps://sctt.org.uk/wp-content/uploads/2017/05/A-National-Service-Model-for-HMHM-v1.1.pdf

National HMHM Evaluation Reporthttps://www.digihealthcare.scot/home/news-and-events/news/

HMHM work stream and community of practice national dataset reports https://www.digihealthcare.scot/home/resources/technology-enabled-care-tec/tec-news-resources/

Optimising Remote Monitoring & Long Term Conditions Projectionshttps://sctt.org.uk/programmes/home-and-mobile-monitoring/long-term-conditions/

MDMW site: A digital story: self management videohttps://www.youtube.com/watch?v=Y21gks2I29E

Telecare Feasibility Studyhttps://www.ehealth.scot/tec-feasibility-report-published/

March 2018 national telecare eventhttps://sctt.org.uk/programmes/telecare/national-telecare-events/tec-national-telecare-event-22nd-march-2018/

National Telecare dataset and benchmarking activityhttps://sctt.org.uk/programmes/telecare/telecare-data-collection-analysis/benchmarking-group/

List of Publications and Resources Referenced


Telecare monitoring returnshttps://www.digihealthcare.scot/home/resources/technology-enabled-care-tec/tec-news-resources/

Technology Charter for People with Dementia in Scotlandhttps://www.alzscot.org/assets/0002/0289/Technology_Charter_for_People_with_Dementia_in_Scotland.pdf

Alzheimer Scotland Dementia Circlehttp://www.dementiacircle.org/

Alzheimer Scotland Digital Twitter Feedhttps://twitter.com/AlzScotDigital

Alzheimer Scotland Purple Alerthttp://purplealert.org.uk/

VC using Attend Anywhere Progress Reporthttps://sctt.org.uk/wp-content/uploads/2018/08/Attend-Anywhere-review-v10.pdf

Attend Anywhere Presentations and Reportshttps://sctt.org.uk/programmes/video-enabled-health-and-care/attendanywhere/presentations/

NES Supporting Scotland’s Workforcehttps://nes.scot.nhs.uk/newsroom/media-releases/supporting-scotlands-workforce.aspx

Digital Health and Care Learning and Support Resourcehttps://learn.nes.nhs.scot/2198/technology-enabled-care

Technology Enabled Care in Housinghttps://techousing.co.uk/

Linstone Housing training and use of Digital Tec in Renfrewshire videohttps://www.youtube.com/watch?v=L0i4Ep_VQww&feature=youtu.be

Innovation Networkhttps://www.alliance-scotland.org.uk/digital/digital-health-and-care/innovate/innovation-network/

WG13, community café and digital hub in Kilmarknockhttp://wg13.co.uk/about/

Technology Enabled Care (TEC) – East Renfrewshire Councilhttp://www.eastrenfrewshire.gov.uk/tec

TEC – A Social Worker’s storyhttps://www.youtube.com/watch?v=NKtJmxn8tew&feature=youtu.be

NHS Forth Valley falls and frailty videohttps://www.youtube.com/watch?v=QyDF4eW8ZNY&feature=youtu.be

NHS Lanarkshire Attend Anywhere videohttps://www.youtube.com/watch?v=ed5Rb9Bcs-k&feature=youtu.be

YoungScot TEC Reporthttps://www.digihealthcare.scot/home/resources/technology-enabled-care-tec/tec-news-resources/

TEC Annual Report 2017-2018https://www.digihealthcare.scot/home/resources/technology-enabled-care-tec/tec-news-resources/

Digital Platform Definition and Services Reporthttps://www.digihealthcare.scot/home/resources/technical-architecture/


Connect with us @TECScotlandContact us via [email protected]

review and highlight report 2015-2018 - digi health care€¦ · the content draws on a...

Documents