Forget S.P.E.C.T.R.E, Mr Bond
S.L.O.T.H is the enemy!
Professor James Ferguson,
Professor of Remote Medicine,
Robert Gordon University
Clinical Lead,
Scottish Centre for Telehealth and Telecare
Consultant Surgeon in Emergency Medicine,
NHS Grampian
The Enemy - SLOTH
• Secret
• League
• Opposed
• To E
• Health
Mission: To Create CHAOS
CHAOS
•
•
•
•
•
Choose
Hospital
Admission as
Only
Solution
Creating CHAOS
• Which environment will do the following?
– Increase Inpatient mortality by 20%
– Increase Inpatient Length of Stay by 1-3 days
– Increase likelihood of errors
– Increase complaints and litigation.
ED Door to medical team time
30-day adjusted mortality
All cause mortality (%)
P < 0.0001
20.0
17.4
16.0
12.6
12.0
8.0
5.8
6.4
<2.5 hr
<4 hr
8.6
4.0
0.0
< 6 hr
< 9 hr
>9 hr
Combating SLOTH
Which environment produces:
• a 15% reduction in A&E visits.
• a 20% reduction in emergency admissions.
• a 14% reduction in elective admissions.
• a 14% reduction in bed days.
• a 45% reduction in mortality rates.
Combating SLOTH
Which environment produces:
• a 15% reduction in A&E visits.
• a 20% reduction in emergency admissions.
• a 14% reduction in elective admissions.
• a 14% reduction in bed days.
• a 45% reduction in mortality rates.
KERR
REPORT
Kerr Report 2005
• ensure sustainable and safe local services;
• view the NHS as a service delivered
predominantly in local communities rather
than in hospitals
The Healthcare Quality
Strategy for Scotland:
Effective
The most appropriate treatments, interventions,
support and services will be provided at the
right time to everyone who will benefit, and
wasteful or harmful variation will be
eradicated
The 00’s
•
•
•
•
Sleekit
Crusaders for
Telehealth and
Telecare
COMMUNICATIONS
Scotland
Peer Review
Improved care: 33% (Range 20% to 60%)
Avoided transfer : 25% (Range 15% to 50%)
Method
• 5 minute Video
• Cue Cards
Who is Who?
EM doctor with several years
US experience
Supervisor’s 14 year old
Daughter
Pre-hospital
Combating SLOTH – Information is Power
Electronic Health Record
• ECS
• PCS
• KIS
Combating SLOTH
Planning Unscheduled Care
• Anticipatory Care Plans
• Palliative Care Plans
• Living and Dying Well
Combating SLOTH – Intelligence gathering
Spying : Community Health Index
• Clinical, not flow
• Independent
Technology-Enabled Care (TEC) Programme
Background
•
Tied to Health & Wellbeing Outcomes
•
Designed to significantly extend the numbers of people directly benefiting from technology
enabled care and support in Scotland :
To enable greater choice and control in health, care & wellbeing services for an additional
300,000 people by March 2016, enabling more of our citizens to remain at home and in their
communities.
•
Benefits from £10 million in funding for 2015/16, with the opportunity for additional £10
million per year for 2016/17 and 2017/18 based on positive outcomes in 2015/16
•
Local areas challenged by the Cabinet Secretary to show how technology enabled care
contributes to avoiding unnecessary hospital admissions, reduces length of stay and prevents
delayed discharges from hospitals in all locations across Scotland.
•
5 Key Workstreams identified for funded along with an additional overarching Improvement
Programme
Five priorities for the TEC Programme
• Extending the use of home health monitoring
• Expanding use of video conferencing across all health and
social care sectors, as well as growing its use for
clinical/practitioner consultations
• Building on the emerging national digital platforms to enable
direct access to advice and assistance
• Expanding the take up of Telecare with focus on prevention,
points of transitions in care and dementia
• Exploring the scope and benefits of switching from analogue
to digital
Technology-Enabled Care Programme – The Story
So Far……
•
•
Not to support more pilots but to focus on scaling up and service integration
Current priorities for health and social care integration are embedded in the
programme
• 46 Areas requested funding – requests totalled > £ 16Mil
• 21 were successful in gaining funding– although not all at the level they
had requested
• Funding agreed and about to allocated out
• Programme Implementation Phase starts April 2015
Stakeholders
Areas Funded 2015/16
Partnerships
3rd &
Independent
Sector
NHS Board
Execs
Local
Authority
Execs
Telehealth &
Telecare Leads
Scottish Govt
Directorates/
Housing
Organisations
Divisions
TEC
Health &
Social Care
Practitioners
Accountable
Officers
Health &
Social Care
SCTT
Citizens
eHealth Leads
DHI
Partnerships
Aberdeen City
Angus
Argyll & Bute
Lanarkshire
Midlothian
Lothian
Ayrshire & Arran
Borders
Orkney
Perth & Kinross
East Renfrewshire
Edinburgh
Glasgow
Highland
Renfrewshire
Western Isles
West Lothian
Collaborative
Submission
Organisation
Submissions
Adapting for Change Quarriers
Scottish Fire & Rescue
24-9-01
EXPANSION OF HOME HEALTH MONITORING
Background
Anticipated Outcomes
• Large number of small project
• Increase in number of people
initiatives with positive outcomes on
who can be supported at home
avoided admissions/patient
• Reduced emergency admissions
experience/mortality - existing service • A scaleable, cost and clinically
models not cost effective or targeted
effective service model
to best impact.
•
DIGITAL Home Monitoring services for
Diabetes/Lung Disease/Heart Failure etc
Give patients
responsibility
EXPANSION OF NATIONAL VC INFRASTRUCTURE
Background
Anticipated Outcomes
• Successful national coordination and management
of VC within NHS Scotland
• SWAN national procurement
contract in place to enable
collaborative and cost
effective procurement
• National VC standards in
place
• Integrated VC across health,
local authority, third and
independent sectors in at
least 2 geographies
• No of tech enabled
consultations with citizens
doubled
EXPANDING & EXTENDING DIGITAL PLATFORMS
Background
Anticipated Outcomes
• Creating a national digital
platform framework, learning
from, and potentially building on,
national initiatives such as Living it
Up and ALISS to expand supported
self-management information,
products and services for Scottish
citizens
• LiU expanded to further two
geographical areas, increased
usage to 80,000 people
• Quicker adoption/deployment,
reduced duplication of effort
• Clarity on connectivity and
information standards
TEC Example - EXPANDING & EXTENDING DIGITAL
PLATFORMS
LIVING IT UP (LiU) – www.livingitup.org.uk
EXPANSION OF TELECARE
Background
Anticipated Outcomes
• Successful 5 year Telecare
Development Programme to
March 2011
• Particular interest on
prevention, care transitions
and dementia
• A significant increase in the
number of people with
dementia supported at
home/community
• Telecare is a mainstream and
integrated part of care
planning
SCTT lead
EXPLORING SCOPE & BENEFITS OF DIGITAL TELECARE
Background
Anticipated Outcomes
• Current telecare technologies
are predominantly analogue
(telephone) rather than IP
(broadband) based
• Analogue is increasingly
outdated and expensive for
Teleco’s & data system users
likely switching to IP
• Supports shared info and
technology interoperability
• Detailed feasibility report
scoping out costs, benefits and
methods of moving from
analogue to digital
MACHIAVELLI
•
Let it be noted that there is no more delicate matter to take in hand, nor more dangerous to
conduct, nor more doubtful in its success, than to set up as a leader in the introduction of
changes.
For he who innovates will have as his enemies all those who are well off under the existing
order of things, and only lukewarm supporters in those who might be better off under the
new.
This lukewarm temper arises partly from the fear of adversaries who have the laws on their
side and partly from the incredulity of mankind, who will never admit the merit of anything
new, until they have seen it proved by events.
The result, however, is that whenever the enemies of change make an attack, they do with all
the zeal of partisans, while the others defend themselves as feebly as to endanger both
themselves and their cause.
"The Prince" Niccolò di Bernardo dei Machiavelli published in 1513
Born 3 May 1469 Florence, died 21 June 1527 Italian diplomat and political theorist