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ESSAY QUESTION

Case Study: Ruskin Metropolitan Borough Council (RMBC)

It can be argued that innovation and entrepreneurship was at the heart of the creation of the National Health Service (NHS). Aneurin (Nye) Bevan its chief architect described the NHS as a ‘great and novel undertaking’. “From the cradle to the grave” it was the central plank of the emerging ‘Welfare state’ to rid the nation of disease. Scientific and technological developments have brought about clinical and organisational change in the evolution of the organisation’s 72 years’ of service. This has resulted in people living longer and consequently there is increasing demand for its services. Not only are people living longer they are living with multiple and complex needs. There is also the expectation that the quality of care provided of a high standard.The structural and financial reforms that have taken place since 1979 has transformed the service tremendously and provided the impetus for integrating health and social care. Tele care and Telehealth are the most recent innovations that have been introduced to manage the shortfall in funding whilst meeting increasing demands for the service. These innovations are aimed at providing services for an ageing population in the 21st century.

Ruskin Metropolitan Borough Council (RMBC) serves a population of over 290k people. It is predicted that by 2020 there will be a 5% growth in over 65s and 11% growth in over 85s. In 2017/ 2018 the council received 8, 973 request for adult social care with 706 enquiries coming from the over 65s.

The 2016 population data revealed that 19.7% of RMBC’s population (57,100) are in the 65 plus age group. It is estimated that by 2026 the population for this age group will increase to 22.2% to (67.600); for the 85 year olds the figure is projected to be 3.4% (10,400). Dementia was one of the conditions that were putting significant pressure on health and social care in the authority. It is reported that 2,800 residents have dementia. There are 33.3% of people living with two or more long term condition. In addition to this 50% of the council’s residents have a long term health problem or disability. These conditions were impacting on hospital admissions.

To meet this increasing demand for health and social care services and to reduce hospital admissions new models of care needed to be introduced. RMBC decided to work in close partnership with the local Ruskin NHS Trust and a technology company Cloud Care LTD to develop telecare and telehealth models that focused on early intervention and prevention. The council allocated a budget of £120k to the telecare initiative. £30k was identified for the first phase of the project with the reminding £90K for implementation.

RMBC created the Triage Assessment Team (TAT) to work with Cloud Care’s Telecare monitoring call centre. The overall objective was to support people to remain within their homes or place of residence and continue to live independent lives. By introducing technology through telecare into care plans it aimed to reduce the need for a higher level care or more prolonged care, thereby reducing costs and hospital admissions,

The authority had previously put in place a telecare service that has been supporting 1,500 people to remain safe within their home or place of residence, and to live independent lives. However, the take-up and impact of the new models of technology enabled care was not as high as the council had envisaged and the impact was lower than expected. The diagram below shows the take up.

It costs the authority around 1% of the total annual social care expenditure to provide telecare to around 38% of the residents receiving some form of social care. The TAT team was seen as the vehicle to increase telecare by focusing on (potential) older users of the current telecare service as this was the average user profile. There was evidence that it would be easier to engage with this group rather than service users with disabilities or people to being discharged from hospital. The TAT team’s remit was to carry out robust functional assessments with suitable service users at first contact and resolve issues quickly, avoiding delays and unnecessary Care Act assessments

The TAT team’s work ensures that RMBC delivers the ‘prevent, reduce, delay’ principles of the Care Act, and aligns perfectly with quick and timely installation of telecare equipment. Working in conjunction with Cloud Care, TAT began the fast track trail for testing quicker installation of telecare alert equipment by front line staff at assessment visits. These included fall detectors, bed sensors and personal alarms. The team chose a telecare care kit that was easy to pre-progamme and install. It operated by using built in roaming SIM and IP compatible for the digital switch over. The kit has a main base unit and can be supplied with a simple easy to press pendant or with a falls detector depending on the user’s needs. A vital component in providing telecare equipment is ensuring response services can offer appropriate support by having quick and easy access to a service user’s property. This is done through provision of a permanent keysafe.

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