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

2.0 Achievements

We have made considerable progress in the last five years and Scotland is recognised internationally as a leader in the development and deployment of telehealth and telecare.

Significant milestones:

• First National Telecare Strategy (2008) and Telecare Action Plan 2010-2012.
• The Joint Improvement Team's (JIT) Telecare Development Programme (TDP) which invested just over £20 million over five years from 2006-2011.
• First National Telehealth Strategy (2010) and four national Telehealth programmes in Stroke, Paediatrry B
• ics, Mental Health and Long Term Conditions plus developments in the technology infrastructure, education and training.
• A single integrated Scottish Centre for Telehealth and Telecare (SCTT) is now embedded within NHS 24, NHSScotland's national, technology-enabled service provider, with excellent links and relationships with local authorities and other key stakeholders.
• A National Telehealth and Telecare Advisory Board (NTTAB) is established to inform and drive the strategic direction on Telehealth and Telecare.
• The Scottish Assisted Living Programme Board (SALPB) is in place which links to Scotland's Life Sciences Adviso
• oard and Technology Advisory Group, secures and drives development and economic opportunities across a community of academia, industry, third sector organisations and health, housing and care practitioners.¹¹

Key achievements:

This snapshot of recent progress illustrates the contribution made by telehealth and telecare to integrated care that improves quality and delivers better outcomes.

• Around 44,000 people (including over 4,000 people with dementia) received a telecare service as a result of the national Telecare Development Programme between 2006 and 2011, helping to expedite 2,500 hospital discharges and to avoid 8,700 emergency admissions to hospital and over 3,800 admissions to care homes. The external evaluation also highlighted the improved quality of life experienced by both service users and carers.
• The North of Scotland Planning Group is now implementing a Single Point of Contact for paediatric unscheduled care. Paediatric Consultants will provide critical decision support via video link to Rural General Hospitals who do not have 24/7 paediatric clinicians. It is anticipated that this will reduce the amount of emergency transfers of children between hospitals, allowing them to be supported locally.
• People living within 11 out of 14 territorial Health Board areas in Scotland now have access to 24/7 stroke thrombolysis treatment through Telestroke networks that provide access to immediate stroke specialist decision support using video conferencing and digital imaging. Approximately 80% of strokes are caused by a blockage of blood supply to part of the brain. Thrombolysis is the use of clot-busting drugs to open up these blocked arteries. However, to be effective, thrombolysis treatment for stroke must be given within 4.5 hours from the onset of symptoms. Based on the national stroke audit figures for 2011, Board areas who had implemented telestroke had a 147% increase in treatment rates compared to a 23% increase in treatment rates for Boards not using (or not requiring) telestroke during the same timescale.
• £10 million funding has been successfully secured as part of the UK-wide Technology Strategy Board's Delivering Assisted Living Lifestyles At Scale (dallas) competition. The 'Living It Up' Project aims to provide improvements in health, wellbeing and lifestyles for over 55,000 people (10,000 with long-term health and care issues) living in five geographic areas across Scotland over a three year period, and to support economic benefits.
• Scotland Excel, in collaboration with 32 Local Authorities, Hanover and Bield Housing Associations and the JIT published a national framework agreement for the procurement of telecare equipment and other services. This aims to provide cost efficiencies of approximately £300,000 per annum and improvements in interoperability between different suppliers' equipment. The framework was published in January 2012, with estimated average savings of 8.8% evidenced over the first six months. Scotland Excel has ensured this framework is also open to NHS purchasers.
• Around 77% of CH(C)Ps have developed or are progressing pathways between community alarm/telecare services and falls prevention, assessment and rehabilitation services; and 60% of CH(C)Ps access data from community alarm/telecare services in order to provide early interventions which reduce risk of harm for older people who have fallen.
• NHS National Services Scotland, the North of Scotland Planning Group and the SCTT have improved the infrastructure for internet based video conferencing across the N3 network. This has resulted in a single service, enabling staff to contact each other across the whole of NHSScotland. The service supports one-to-ones and group conferences, with six or more locations possible. There are now over 660 video conferencing units as part of the service, covering all NHSScotland Boards, averaging over 100 conferences per day and saving around 1,000 tonnes of CO2 per quarter. Feedback from Health Boards shows video conferencing is now increasingly being used for clinical consultations and has improved the quality of patient care in rural areas, where patients can attend a local clinic with the consultation taking place via video conference.
• Early adoption of Video Conferencing between Mental Health units and two Scottish Prisons is delivering specialist mental health services to the prison population; in addition, Psychiatry of Old Age teams are also prototyping video conferencing to provide specialist advice to staff in care homes in order to optimise care and prescribing for people with dementia.
• By the end of March 2012, 179 people in Dumfries and Galloway, Lothian and Tayside had participated in video conference/telelinked pulmonary rehabilitation classes that enable more people from across Scotland to access support for self management and enablement.
• New competency frameworks for telehealthcare now support staff, professionals and those working in informatics and can be accessed through an integrated Telehealthcare portal on the NES Knowledge Network.
• A validated Professional Development Award (PDA) in Telehealthcare supported by a consortium of SQA Approved Centres who are developing assessment exemplars and learning support materials for the integrated workforce in the absence of existing accredited and recognised qualifications and learning materials.
• Integrated Telehealth and Telecare Learning Network provides monthly webcasts (viewed by approx 200 people) and hosts annual national conference events to exchange learning, highlight recent activities and advances in Telehealth and Telecare, and share lessons learned.