March 2010: WSD Programme update

Frequently asked questions about the Whole System Demonstrator (WSD) programme

At the Stansted conference on 11 February 2010, WSD Programme Manager Tim Ellis took the opportunity to answer some of the most frequently asked questions about the programme(2625 kb) .

Question: What is the aim of the WSD programme?

Answer: We want to know to what extent the WSD model of care:

promotes individuals’ long-term well-being and independence
improves quality of life for individuals and their carers
improves the working lives of staff
is more cost-effective
is more clinically effective
provides an evidence base for future care and technology models.

Question: How many people are involved in the trial?

Answer:

239 GP practices have signed up.
More than 27,000 letters have been sent out to potential participants.
More than 9,000 home visits have taken place.

There are 6,191 participants on the trial, of which:

5,721 are telecare and telehealth users (half control, half installs)
470 are carers.

The trial will continue through 2010 as all of the active participants are followed up at 12 months.

Question: What is covered in the evaluation?

Answer: There are five themes asking various questions with a number of participants involved in each aspect of this evaluation.

THEME	Question	NO. PARTICIPANTS REQUIRED
1	*Does the introduction of telehealth or telecare result in reduction in service utilisation and costs of care?*	5,721 participants Combined Model
2	*What is the effect on carer burden, self-care behaviours and quality of life? What predicts whether people will use the service as planned?*	3,160 participants 470 informal carers
3	*What is the effectiveness of the introduction of telecare and telehealth?*	3,160 participants 470 informal carers Professional interviews
4	*What are the service users, informal carers and health and social care professionals’ experiences of telehealth and telecare?*	45 participants and informal carers 15-30 non-participants 75 health and social care professionals
5	*What organisational factors facilitate or impede the sustainable adoption and integration of telehealth/telecare?*	45 key WSD managers and commissioners in health and social services Staff from 3 WSDAN sites and 3 non-WSD related sites

Question: What sensors and packages are being used for people with varying levels of need?

Answer:

Every individual on the programme has had an assessment.
There is a minimum telecare package that includes lifeline, pendant, smoke alarm and other environmental sensors.
Additional sensors are provided tailored to individual needs (eg, falls monitors, bed sensors, property exit sensors).

Question: How are alerts and monitoring reports picked up by care managers at the three WSD sites?

Answer:

All three sites have contracted arms-length bodies or the private sector to provide the monitoring.
There is a chain of nominated responders for each individual (eg, carer, warden or family/friend); emergency services are contacted as a last resort, depending on the incident and the individual’s personal circumstances.
Everyone has a care plan following their assessment, which states what the response should be and who should be involved, together with the response thresholds – we probably underestimated the amount of effort that this process would take.

Question: Which telehealth peripherals are being used for people with different long-term conditions and co-morbidities?

Answer:

Each of the sites is using different telehealth vendors but the vital signs being measured tend to be the same.
Suppliers offer telehealth packages for different conditions with appropriate peripherals (eg, diabetes – blood sugar and weight scales; congestive heart failure – weight scales; and COPD – pulse oximeter).
Additional peripherals are added for co-morbidities based on advice from the clinician and tailored to the individual’s circumstances.
Some peripherals are connected by cables or Bluetooth and link to a television set or a standalone unit.

Question: What type of training do nurses and community matrons receive to provide the service?

Answer:

Suppliers have provided initial training. Training has then been taken in-house for roll-out (this includes deployment, training for users, back-office systems).
There is individual tailoring for users, including relevant questions and frequency of monitoring appropriate to condition.
Sites use different styles and scripts. There are some core scripts across the sites, required for the evaluation.
Continuity of care – in some cases it is always the same person who makes contact with the individual; in other cases, a number of people are involved.

Question: Are there any differences in monitoring approaches across the three sites? How often do participants take readings?

Answer:

Cornwall – monitored by community matrons (includes people with more severe conditions and those that have had emergency admissions in the last year).
Kent – monitored by community matrons (people with previous emergency admissions) or monitoring centre (people who have not had recent admissions). In the latter case, escalation is to the GP where readings are out of range.
Newham – dedicated monitoring centre staffed with community matrons and nurses.
Slightly different approaches across the sites reflect different service arrangements and starting points.
Frequency of monitoring varies, based on a discussion between an individual and a clinician. Most individuals are monitored daily.
All of the sites use a traffic light system to indicate when it is important to investigate further. Trends are monitored – it is not an emergency service.

Question: What are the key learning points about installation, monitoring and response when working at scale?

Answer:

The level of planning and basic project/programme management involved is really significant when working at scale and at speed.
It is important to plan installations and work closely with the supplier/install team. There needs to be flexibility in these arrangements.
Demand management is important – people have come on and off the trial in spikes, so the demand is not even. This affects resourcing and staffing arrangements.
Don’t underestimate the technical and logistical issues – eg, power sockets and telephone line in the home, availability of broadband (for instance, Newham has an eight-day turnaround for connections for their telehealth service).
There is a need for flexibility in arranging assessments and installations, including out-of-hours service, as people can have active and busy lives even though they have high levels of need.
Communications are important for staff and service users – eg, setting expectations, booking visits.

Question: Are there any examples where a person has had both telecare and telehealth?

Answer:

Initially, it was anticipated that there would be people that would have both telehealth and telecare. However, in reality, very few people met both the health and social care criteria for the trial.
This overlap group was removed from the trial as it would not have been possible to have a large enough group for statistical significance and validity of results.
Essentially, there are separate telecare and telehealth groups in the trial, with some crossover (eg, medication reminders).
There are some non-WSD people with telecare and telehealth services – it will depend on eligibility, user need and other factors.

Question: Are there any early lessons for integrated working from across the three sites?

Answer:

Senior commitment is necessary.
Data sharing and handover are important – initially, we underestimated the time for setting up data sharing agreements and ensuring the slick handover of responsibility from one organisation to another.
Pockets of excellence may not spread across a large local authority area – it is important to work towards high standards.
The WSD programme is recognised by the sites as a vehicle for more integrated working.
There are differences in culture, motivation and performance metrics between organisations (including the private sector and the third sector).
A common goal is needed.

Question: Are there any learning points about working with suppliers, third sector and independent organisations? What is the role of housing services?

Answer:

Many of the participants were already working with earlier telecare and telehealth programmes in the sites at a smaller scale. Some organisations were new.
It is important to work with housing services and the third sector – many organisations are already providing services that should be part of a total care package.
It is important to ensure flexibility, and that contracts and service level agreements are in place.
Governance must be in place to handle sensitive personal information.
It is important to work with voluntary organisations to raise awareness and set up user forums – to hear the user voice and allow people to share their experiences.