A National Telehealth and Telecare Delivery Plan for Scotland to 2016: Driving Improvement, Integration and Innovation

1.0 Introduction

The Changing Landscape

Scotland's society is changing. Over the next 10 years the population aged over 75 years in Scotland will increase by over 25%, and by 2030 will increase by over 60%).¹ There will be growing numbers of adults who have multiple long-term conditions, many also challenged by mental illness. The ratio of people aged under 16 or over pensionable age to those of working age is projected to increase, resulting in fewer workers per dependents. Many of us are already taking on roles as unpaid carers for our families and friends whilst trying to sustain income levels, employment and quality of life. There are an estimated 657,300 carers in Scotland² and 23% of all carers are caring for 50 hours or more per week.³

Existing financial challenges within the public sector are already exerting significant pressure on health, care and support models. With the loss of several billion pounds from public sector budgets over the next few years, we simply cannot continue to deliver our services in the current way. We need new and different approaches to prevention, enablement and to supporting independence, wellbeing, self care and self management.

Technology

Technology plays an increasing role in our everyday lives. The eHealth Strategy for Scotland 2011-17 reaffirms the pivotal role of telehealth and telecare technologies⁴ to radically transform the way health and care for people of all ages is delivered across Scotland. Deployed thoughtfully and appropriately as part of service redesign, telehealth and telecare can:

• support people to have greater choice, control and confidence in their care and wellbeing;
• enable safer, effective and more personalised care and deliver better outcomes for the people who use our health, housing, care and support services;
• help generate efficiencies and add value through more flexible use of our workforce capacity and skill mix and by reducing wasteful processes, travel and minimising access delays.

"Telehealth provides an opportunity to treat patients in new ways and help manage rising costs and demand" and that "economic modelling work suggests that using telehealth to monitor patients with COPD at home has the potential to offer better value for money than conventional care."

(Audit Scotland: A Review of Telehealth in Scotland, Oct 2011)

Telehealth and telecare can be deployed in all sectors and across the breadth of our care pathways: within the home; in primary and community care; in supported housing, hospitals and care homes; and within our emergency care services. Access to these technologies and services should not be restricted by client grouping, point of care, or health condition as they assist in a very wide range of health, care and support situations from early years through to end of life.

However the technology itself is not a panacea. As global innovation produces ever smarter and more sophisticated technology, this will only be adopted if our care systems adapt to embed it through service redesign and new ways of working. We need to build public and professional awareness and confidence in how technology can make a difference to our lives, and ensure it is reliable and easy for all to use.

Scotland has already made good progress in the deployment of telehealth and telecare over the past few years, and is recognised by the European Commission as a leader in this field. It is essential to build on this progress, not only to fully capitalise on this investment, but to ensure that the potential for telehealth and telecare to support patients, carers and service users across Scotland in receiving the best care and support possible is realised. We will continue to raise awareness, spread good practice, challenge variation, and continue to innovate and to spread 'technology-enabled' service redesign and improvement at scale.

National Delivery Plan for Scotland

This National Delivery Plan responds to these challenges and sets out the vital contribution that telehealth and telecare will make to implement key health, care and housing strategies in Scotland over the next three years (2012-15).

This includes an increased focus on prevention, advocated in the Christie Commission's report on the future delivery of public services,⁵ prioritising those services which help to reduce the likelihood of negative outcomes.

Renewing Scotland's Public Services, the Scottish Government's response to the Christie Commission:⁶ Telehealth and telecare are well aligned and are critical enablers for the four pillars of public service reform - prevention, partnership, workforce development and performance and the seven outcomes of successful public service reform - Assets based and co-production; Values driven; Person- centred outcomes; Prevention, reducing demand in the longer term; Integration and partnership; Workforce development and leadership; and Performance improvement. The response supports accelerated progress in building prevention into the design and delivery of public services and better utilisation of the talents, capabilities and potential of Scotland's people and communities. It also identifies a crucial role for the third sector, due to its ability to engage with vulnerable groups and use of flexible and innovative approaches.

Reshaping Care for Older People and Early Years: These approaches are fundamental to supporting the redesign and development of our health, care and support services for these target population groups, and recognise the contributions that can be made from technological advances.

Age, Home and Community: A Strategy for Housing for Scotland's Older People 2012 - 2021:⁷ The first National Housing Strategy for Older People was published jointly with CoSLA in November 2011, and encourages the development of technology as a key element in supporting more older people to live independently at home, and pledged to continue to develop and mainstream the use of telecare.

The Healthcare Quality Strategy for Scotland⁸ is the basis for NHSScotland, with its partners and the public, to deliver world-class, person-centred, safe and effective health and care services. It puts people at the heart of everything we do and aims to deliver measurable improvement in outcomes. Further development and adoption of telehealth and telecare will enable significant progress against all three Quality Ambitions for Safe, Effective and Person-centred care. The 2020 Vision⁹ provides the strategic narrative and context for taking forward the implementation of the Quality Strategy, and challenges us to embrace integration and adopt innovative models of care to deliver better outcomes and sustain a high quality health and care system - "Our vision is that by 2020 everyone is able to live longer healthier lives at home, or in a homely setting. We will have a healthcare system where we have integrated health and social care, a focus on prevention, anticipation and supported self management. When hospital treatment is required, and cannot be provided in a community setting, day case treatment will be the norm. Whatever the setting, care will be provided to the highest standards of quality and safety, with the person at the centre of all decisions. There will be a focus on ensuring that people get back into their home or community environment as soon as appropriate, with minimal risk of re-admission."

Community Planning Partnerships:¹⁰ Designed to provide Best Value, Community Planning and the Power to Advance Wellbeing, tied into the Single Outcome Agreements. Community Planning is intended to provide "trust within a framework", empowering Local Government, with its partners, to take ownership and drive forward improvement in local services which make a real difference to people's lives. A Statement of Ambition was agreed between the Scottish Government and CoSLA in March 2012 which places community planning "at the heart of public service reform as a key means to drive integration, encourage a focus on prevention and improve performance all with a view to achieving better outcomes for communities".