A council plans to integrate health and social care services in their new model of care. Walsall Metropolitan Borough Council executive director of adult social care and inclusion Paul Davies discusses how telehealth is fundamental to this service redesign.

With concerns over the impact on health and care services, an ageing population, improved life expectancy and more people living with complex conditions, how do you find a solution that meets care needs and supports independent living, while making the best use of available resources?

This is the situation we face in Walsall. NHS Walsall has approximately 37,000 patients with long-term conditions such as chronic obstructive pulmonary disease, heart failure and diabetes living in the area, with 39 per cent of households having one or more persons living with a long-term condition.

Of these patients, an estimated 3,300 created 4,000 emergency admissions alone in 2009-10, equating to approximately 25,000 bed days and a commissioning cost of £12.9m per year.

Combined with improved life expectancy and an increasing number of people living with long-term conditions, the pressures on local health resources will continue to grow at an unsustainable rate. Walsall needed a solution that would meet these growing needs, and would support people in living fulfilled lives while making the best use of local resources.

We decided that in order to more effectively meet the needs of our clients, we needed to introduce a model of care that integrates both health and social care services into one manageable solution.

The Department of Health recently identified four quadrants of an ideal health and social care service, combining social capital, telecare, individual choice and prevention.

Our plans for Walsall are to develop a service that integrates these key principles by representing the latest thinking in social care, using technology to enable change that allows us to cater for individuals in a way that health and social services have never done before.

We want to be able to maximise the potential for individuals to take control of their own lives and allow all people, regardless of background, to access mainstream services and provisions. By providing clients with telehealthcare as standard, we hope to allow people to live independently for as long as possible, safe in the knowledge that help is at hand whenever necessary.

Telecare and telehealth solutions, such as those from Tunstall Healthcare, support the priorities of a joint health and social care service, providing the essential back up that people need to support them at home, 24 hours a day, 365 days of the year. This ensures a systematic shift towards early intervention, prevention and service modernisation in the context of rising expectations.

In the past, money has been used ineffectively through providing labour intensive, inappropriate and low quality care services to people who didn’t benefit from them.

True personalisation requires the integration of all services around the individual in order to ensure that assistance is targeted and there is an economy of effort in their delivery.

Co-ordinating the activity of multiple teams can be costly, which is why Walsall plans to redesign the community care and adult social care pathways with telecare as a foundation, coordinating health and social care services to ensure the right care can be delivered appropriately.

While overall crime rates in Walsall have continued to drop since 2000 compared to national rates, figures show that fewer people feel safe now compared to three years ago. We plan to use telehealth to provide support and reassurance to enable vulnerable people to feel safe and confident in their own homes and communities.

Case study - night wandering

Gentleman B lives in one of Walsall’s Extra Care Schemes with his wife of 63 years, where they have been settled and happy for many years. However, when Gentleman B developed dementia and began wandering out of his flat during the night, a great deal of stress was placed on him and his wife.

A telecare package incorporating a door exit sensor was discussed with the couple, their support team and their family. The telecare package has allowed staff to respond much faster when Gentleman B leaves his flat, thus minimising the risks to himself and the distress to his wife.

The cost of Gentleman B’s telecare package totalled £390. This includes installation and is a stark contrast to the annual cost of EMI residential care, which would have been in excess of £20,000.

Telehealthcare also bridges the gap between those who retain a high level of functionality and those who don’t, enabling people and groups who may not have benefited from developments in technology in the past, to gain more independence in a way that is meaningful and effective.

Case study - epileptic fits

Telecare can also provide care and support for the younger population who suffer from long-term conditions that affect their independence. Gentleman A is a young man who suffers from epilepsy and severe learning difficulties. Due to breathing difficulties caused by the severity of his fits during the night, Gentleman A has always slept with a family member to ensure he is never far from help.

His parents understood that the situation was not ideal and needed to implement a solution that could monitor his fits in order to give the whole family some personal freedom.

An epilepsy sensor has played a key role in allowing him to have a room of his own for the first time and the family to regain some independence without compromising Gentleman A’s health. If he has a fit, his parents are immediately alerted and can respond instantly.

Despite some progress, Walsall’s population continues to exhibit lifestyles and behaviours that fall below the national average. Telehealth will be instrumental in improving public health in Walsall, as a convenient and non- stigmatised way of managing long term conditions, using a method that is more effective than having to attend lengthy out-patient appointments.

The benefits of telehealthcare are far-reaching and could potentially reduce unplanned hospital admissions and support independent lifestyles. By catching a problem early, be it an issue with medication compliance, falling or general decline, professionals are able to take preventative action and improve outcomes. The technology can also support early discharge and enhance community safety.

Too often, when someone becomes ill, the solution is to automatically admit that person into hospital in order to reduce the burden on residential care homes and transfer responsibility to the health professionals.

By providing a telehealth or telecare package as standard, trusts and care providers can ensure that those vulnerable patients have appropriate care at home, allowing them to remain independent and reducing the number of people moving into residential care homes unnecessarily at great expense. 

Walsall Council and NHS Walsall have made a joint £2.5m investment over two years in telecare, telehealth and a new responsive service. We believe that it will deliver a much more efficient use of resources and give better outcomes for people, aiming to triple its return in health and social care budgets in the next five years.

We intend to further develop the integration with health partnerships and once embedded, will look at further partners in the fields of housing and wardens, joining up all the partner agencies.

I believe technology is at the heart of an integrated system, it’s an unlocker, and an enabler and over time, the people of Walsall will reap the rewards.